TY - JOUR
T1 - Middle cerebral artery aneurysm “neck overhang”
T2 - Decreased postclipping residual using the intersecting clipping technique
AU - Dimitriadis, Stavros
AU - Qeadan, Fares
AU - Taylor, Christopher L.
AU - Yonas, Howard
AU - Carlson, Andrew P.
N1 - Funding Information:
We would like to acknowledge funding from the University of New Mexico Clinical & Translational Science Center (CTSC) (Grant UL1TR001449). The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Publisher Copyright:
Copyright © 2018 by the Congress of Neurological Surgeons.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - BACKGROUND: Middle cerebral artery (MCA) aneurysms continue to be viewed by many as primarily surgical entities. OBJECTIVE: To introduce a new, easily measurable dimension termed “neck overhang,” defined as the amount of the aneurysm that extends proximal to the 2 dimensionally defined “neck” and to evaluate the utility of the intersecting clipping technique (use of straight clip and intersecting fenestrated clip) to adapt to this overhanging segment’s specific dimensions and achieve better obliteration of the MCA aneurysms. METHODS: We reviewed retrospectively 100 MCA aneurysms treated surgically over the last 10 yr at our institution. We identified the clipping technique that was performed (intersecting vs “standard” technique) and we evaluated the presence of a postoperative remnant. We then correlated these with the aneurysm’s overhanging neck length. RESULTS: Forty-three aneurysms were treated with the intersecting clipping technique. The overall rate of remnant was 16%. In the standard group, the rate of remnant was 23%, whereas with intersecting clipping that was 7% (P = .029). Within the standard clipping group, we found that the optimum threshold for length of the neck overhang was ≥1.9 mm in order to predict the occurrence of residual. Applying this threshold to the intersecting clipping technique group resulted in a reduction in remnant from 35% in the standard group to 9%. CONCLUSION: Neck overhang >1.9 mm is associated with a higher chance of postclipping residual aneurysm in MCA aneurysms. The intersecting clipping technique is a versatile technique that can conform to various aneurysms’ geometry and can reduce the rate of post clipping residual for aneurysms with high neck overhang.
AB - BACKGROUND: Middle cerebral artery (MCA) aneurysms continue to be viewed by many as primarily surgical entities. OBJECTIVE: To introduce a new, easily measurable dimension termed “neck overhang,” defined as the amount of the aneurysm that extends proximal to the 2 dimensionally defined “neck” and to evaluate the utility of the intersecting clipping technique (use of straight clip and intersecting fenestrated clip) to adapt to this overhanging segment’s specific dimensions and achieve better obliteration of the MCA aneurysms. METHODS: We reviewed retrospectively 100 MCA aneurysms treated surgically over the last 10 yr at our institution. We identified the clipping technique that was performed (intersecting vs “standard” technique) and we evaluated the presence of a postoperative remnant. We then correlated these with the aneurysm’s overhanging neck length. RESULTS: Forty-three aneurysms were treated with the intersecting clipping technique. The overall rate of remnant was 16%. In the standard group, the rate of remnant was 23%, whereas with intersecting clipping that was 7% (P = .029). Within the standard clipping group, we found that the optimum threshold for length of the neck overhang was ≥1.9 mm in order to predict the occurrence of residual. Applying this threshold to the intersecting clipping technique group resulted in a reduction in remnant from 35% in the standard group to 9%. CONCLUSION: Neck overhang >1.9 mm is associated with a higher chance of postclipping residual aneurysm in MCA aneurysms. The intersecting clipping technique is a versatile technique that can conform to various aneurysms’ geometry and can reduce the rate of post clipping residual for aneurysms with high neck overhang.
KW - Intersecting clipping
KW - Middle cerebral artery aneurysm
KW - Neck overhang
KW - Remnant
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U2 - 10.1093/ons/opx278
DO - 10.1093/ons/opx278
M3 - Article
C2 - 29529311
AN - SCOPUS:85062037209
SN - 2332-4252
VL - 15
SP - 440
EP - 446
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 4
ER -