Use of multiple clips for arterial reconstruction in wide neck intracranial anterior circulation aneurysms

Objective: Aneurysm clips of different shapes, sizes, fenestrated or non fenestrated can be applied for reconstruction of the arteries in cases of wide necked aneurysms. By fashioning different clips and applying them to the aneurysmal neck in patients with wide necked aneurysms, we describe the method of approximation of the inner walls of the neck of the aneurysm extending to the parent artery leading to complete exclusion of the aneurysm from the circulation. This method also confirms the approximation of the intimae on both the sides of the neck. Method: After exposing the aneurysm, its parent artery and the perforators, the aneurysm neck is carefully dissected; the perforating arteries are also carefully dissected away. Appropriate clip selection is made and clip is applied to the neck of the aneurysm so that the walls of aneurysm which extend into the parent artery are also approximated, thus no remnant of the aneurysm is left behind, in the part extending into the parent vessel. Results: Repeat angiograms done after 3 months of surgery showed no regrowth, or incomplete occlusion of the aneurysm. This method of clip application avoids any recurrence or regrowth of the aneurysm. Conclusion: The greatest advantage of this method of the clip occlusion is that it takes care of the part of the aneurysm which extends into the parent artery, so that even the minimal possibility of any aneurysmal remnant is ruled out.