[The one-line principle in classification of cerebral aneurysm clipping]

Despite numerous clipping techniques, a standardized classification based on a single unifying principle remains absent.

To develop a classification of clipping methods based on the one-line principle.

Material and Methods. The classification was developed based on studies by Ishikawa T. et al., who introduced the «ideal closure line» for aneurysm clipping. We analyzed 678 cases of reconstructive clipping of cerebral aneurysms performed at the 3rd Neurosurgical Department of the Burdenko Neurosurgical Center between September 1, 2024, and December 29, 2024.

Reconstructive clipping methods for cerebral aneurysms, based on the one-line principle, were categorized into eight types. Clipping along a one line without segmenting the aneurysm neck, including simple single clipping, simple reinforced clipping, and clipping with tunneling of the efferent artery, was performed in the majority of cases (58.5%). Linear fragmented clipping of individual aneurysm neck segments, including tandem, counter, and cross techniques, tunneling of the parent artery, perpendicular clipping, and combined clipping, was performed in 39.8% of cases. Discrete fragmented clipping with multiple lines of aneurysm neck clamping was used in only 1.8% of cases.

We developed a novel classification of aneurysm clipping based on the one-line principle. This classification primarily serves scientific purposes, facilitating the evaluation of clinical and angiographic outcomes of various clipping methods across different topographic and morphological variants of cerebral aneurysms.