We have categorized the pitfalls Of aneurysm surgery into 4 groups base on our experience with 1,433 cases.
These 4 groups consists of:
1. Inappropriate preoperative organization of surgical strategies.
2. Inappropriate attitude with repeat to unexpected premature rupture.
3. Inadequate clipping techniques and selection of clips.
4. Unintentional occlusion or injury of perforating branches.
This report provides a presentation of key techniques that we employ for successful acute stage surgery. Our newly designed jet irrigation bipolar system and suction method are used for easy removal of thick subarachnoid clot and obtaining clear access to anatomical structures. Performing a ventricular tap for hydrocephalus and removal of hematoma for hemorrhage cases are necessary for making the brain soft before approaching the aneurysm. A venous pathway should be also maintained for blood circulation.
Clipping on wrapping technique or our newly designed encircling clip is very useful for special occasions, such as blister-like aneurysm and laceration of the neck area or arterial wall. Small arteries and perforating branches from the aneurysm neck or dome can be spared by the use of fenestrated clips.
Tentative clipping and the dome coagulation method with or without short-term temporary clipping allow reliable and secure clipping in case of intraoperative rupture. Since most of the ruptures occur during dissection of the aneurysm neck or neck clipping, these techniques are helpful for certain types of clipping and to lessen ischemic damage.
All of the above strategies for aneurysm surgery yield satisfactory results. This report provides a discussion of the technical management of these pitfalls.
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