45. 特殊な動脈瘤に対するmultiple clipping methods

抄録

Among many techniques to obliterate the aneurysm, clipping of the neck of an aneurysm is one of the most important and the best procedures in this microneurosurgical era. For unusual aneurysms, such as fusiform type, giant, serpentine, with broad or wide neck, it is necessary to use some special techniques to clip without any problem.
Recently we are employing multiple clipping methods for a special aneurysm. This technique requires two or more clips for one aneurysm. These clips are applied to the neck or the dome of the aneurysm in two ways:
1. in pararell way
2. in crossing way
In the pararell application, each clip obstructs the neck or dome only partially, but after using two or more clips the aneurysm is completely occuluded. A problem arises in the cross application that the blades of a second or third clip do not completely close due to the thickness of the blades of previously placed clip. To resolve this problem we utilize a window of a fenestrated clip. Another way to solve this problem is to shorten the blades of a clip by cutting the tip of the blades at surgery. This cutting method of blades is very convenient in the multiple clipping method and also sometimes in the clipping with only one clip.
From January 1980 till May 1983, we operated 450 cases of intracranial aneurysms using various Sugita clips. In this series, multiple clipping method were used in 33 cases without any problems such as incomplete clipping or postoperative stenosis or kinking of surrounding vessels. Every neurosurgeon can obtain an additional number of clips of different forms, angles and lengths as he likes during surgery in this multiple clipping method.