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Updated: Aug 6, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Clot-Vessel Interface-Oriented Microsurgical Strategy for Aneurysmal Subarachnoid Hemorrhage
Toshiyuki Tsuboi1, Masaki Sunaga1, Hideo Ohba1
1Department of Neurosurgery, Itsukaichi Memorial Hospital, Seifu Health Care Group, Hiroshima, Japan.
Background:
Cerebral vasospasm remains a major determinant of outcome after aneurysmal subarachnoid hemorrhage (aSAH). Conventional surgical strategies primarily focus on aneurysm occlusion, whereas the pathological significance of the clot-vessel interface has not been fully integrated into surgical decision-making.
Methods:
We describe an interface-oriented microsurgical strategy for clot removal in aSAH. The technique is based on selective control of the clot-vessel interface using irrigation-assisted loosening and non-contact suction (double suction method). This approach was applied during microsurgical clipping combined with aggressive cisternal clot removal (ACCR).
Results:
In a consecutive series of 65 patients treated with this strategy, symptomatic cerebral vasospasm was rarely observed, and favorable functional outcomes were achieved in the majority of cases.
Conclusions:
The clot-vessel interface represents a rational surgical target in aSAH. An interface-oriented framework provides a reproducible strategy for clot management and may contribute to reducing vasospasm. This concept shifts the focus of surgery from vessel-oriented manipulation to interface-oriented control.
