43. Temporary clip による動脈瘤発生とneck剥離用消息子

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The authors reported two cases of aneurysmal formation as a complication in the use of temporary intracranial arterial clip.<BR>The first case, 48 years old male, was operated on his anterior communicating artery aneurysm through the right pterional approach 40 days after its rupture. During the surgery, the aneurysm ruptured at the time of neck dissection and the right Al poriton was temporarily clipped with Scoville' clip for 15 minutes. The aneurysm was successfully obliterated, but the patient suffered postoperatively from three attacks of subarachnoid hemorrhage and the right carotid angiography 7 days after operation revealed a newly formed aneurysm at the Al portion where the temporary clip had been applied. The patient died 13 days after operation and massive subarachnoid hemorrhage from the rupture of the new Al aneurysm was demonstrated in autopsy.<BR>The second case, 56 years old female, was operated on her right IC-PC aneurysm on the 23rd day after initial rupture, which ruptured during surgery, and the right IC was temporarily clipped at the immediate proximal portion with Heifetz No.107 clip for ten minutes. The aneurysmal neck was successfully clipped, and the right carotid angiography 35 days after operation, revealed an aneurysmal formation on the IC proximal to the clip where the temporary clip had been applied. The right internal carotid was then ligated and the patient was discharged in full activity.<BR>The authors have been using a flexible silver probe with a slightly ballooned tip for aneurysmal neck dissection for these ten years. The diameter of the tip is approximately 1.0 mm and, when it can be passed around the neck of an aneurysm, the blades of the various aneurysm clips can also successfully be passed through the probe's tract. The tip can easily be flexed at any desired angle with fingers during surgery.
The Japanese Society on Surgery for Cerebral Strokeの論文

43. Temporary clip による動脈瘤発生とneck剥離用消息子

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