Clot-Vessel Interface-Oriented Microsurgical Strategy for Aneurysmal Subarachnoid Hemorrhage

Area of Science:

• Neurosurgery
• Cerebrovascular Surgery
• Microsurgery

Background:

• Cerebral vasospasm is a critical factor affecting outcomes in aneurysmal subarachnoid hemorrhage (aSAH).
• Current surgical approaches often prioritize aneurysm occlusion over managing the clot-vessel interface.
• The pathological role of the clot-vessel interface in aSAH outcomes requires further investigation and integration into surgical decision-making.

Purpose of the Study:

• To introduce and evaluate an interface-oriented microsurgical strategy for clot removal in aSAH.
• To assess the efficacy of this novel technique in preventing symptomatic cerebral vasospasm.
• To determine the impact of this strategy on functional outcomes in patients with aSAH.

Main Methods:

• Description of an interface-oriented microsurgical technique for clot removal in aSAH.
• Utilizing selective control of the clot-vessel interface via irrigation-assisted loosening and non-contact suction (double suction method).
• Application of the technique during microsurgical clipping and aggressive cisternal clot removal (ACCR).

Main Results:

• The described interface-oriented strategy was applied to a consecutive series of 65 patients.
• Symptomatic cerebral vasospasm was infrequently observed in patients treated with this method.
• A majority of patients achieved favorable functional outcomes following the intervention.

Conclusions:

• The clot-vessel interface is a viable and rational surgical target in the management of aSAH.
• An interface-oriented framework offers a reproducible approach to clot management, potentially mitigating vasospasm.
• This conceptual shift reorients surgical focus from vessel manipulation to precise interface control.