We report intraoperative difficulties we have encountered during clipping surgery for unruptured cerebral aneurysms.
There is a low risk of intraoperative rupture, but when it occurs, it can be managed either by tentative clipping or proximal flow control. The risk of aneurysm rupture can be decreased by gentle manipulation of the aneurysm, as well as full mobilization of the aneurysm and its neighboring vessels. Adhesions of vascular structures, arteries, and/or veins can be separated from the aneurysm in almost all cases with careful and sharp dissection. Injuries to perforating vessels are the most common problems. The risk of permanent injury can be reduced by combining multiple monitoring methods, especially MEP (motor evoked potential) and micro-Doppler.
It is vitally important that we be aware of the difficulties that may occur during surgery and develop methods to avoid or manage them.
