"Cutoff Clipping" Technique as a Tentative Clipping Alternative for Large Aneurysms: A Preliminary Study

Area of Science:

• Neurosurgery
• Vascular Surgery
• Interventional Neurology

Background:

• Intraoperative aneurysm rupture poses significant risks.
• Thin-walled regions (TIWRs) of aneurysms are linked to increased rupture potential.
• Managing complex aneurysms with TIWRs presents surgical challenges.

Purpose of the Study:

• To evaluate the feasibility of the "cutoff clipping" technique for addressing TIWRs in complex aneurysms.
• To describe the procedural steps and potential concerns associated with this novel technique.

Main Methods:

• The study reports on three cases where the "cutoff clipping" technique was applied to large aneurysms.
• This technique involves dissecting and temporarily clipping the aneurysm fundus based on a proposed TIWRs size threshold.
• The goal is to reduce the fundus size and disconnect blood flow before final clipping of the aneurysm neck.

Main Results:

• Successful application of the "cutoff clipping" technique allowed for size reduction of the aneurysm fundus.
• The proportion of TIWRs was decreased, and blood flow to the distal dome was effectively disconnected.
• All three treated aneurysms were clip-ligated without intraoperative complications.

Conclusions:

• The "cutoff clipping" technique is a viable option for dissecting and clipping complex aneurysms, particularly those with adhesive necks and thin-walled domes.
• This method may enhance safety and efficacy in specific challenging aneurysm cases.