2022 Volume 50 Issue 2 Pages 114-118
In aneurysm clipping, the clip blade is used to drop the dimensions of the aneurysm from a 3-dimensional structure to a 2-dimensional line or curve. Defining the “closure line” as that created by the clip blade, we have promoted the feasibility of achieving ideal clipping without leaving a vulnerable portion by setting this closure line while envisioning the vascular state prior to aneurysm development. This concept is the easiest to apply and the most practical in middle cerebral artery aneurysms due to vascular mobility. Here we discuss the approach of four patterns in which this concept is difficult to apply: 1) when clip insertion along the closure line is challenging; 2) when multiple closure lines are present; 3) when the optimal closure line is ambiguous; or 4) when arteriosclerosis is evident around the neck. This report will help improve the safety and robustness of treating middle cerebral artery aneurysms in which craniotomy plays a significant role.
