Degollado-García Javier, Rodríguez-Rubio Héctor A, Bonilla-Suastegui Alfredo, Serrano-Rubio Alejandro, Nicolas-Cruz Carlos F, Nathal Edgar
Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez', Mexico City, Mexico.
Surg Neurol Int. 2023 Jun 16;14:204. doi: 10.25259/SNI_374_2023. eCollection 2023.
The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occur at the bifurcation. When surgery is selected as a therapeutic option, it intends to clip the neck completely because if some remnant occurs, there exists the possibility of regrowth and bleeding in the short- or long-term.
We analyzed one drawback of the fenestrated clips of Yasargil and Sugita types to occlude the neck totally at a specific point formed by the union of the fenestra with the blades, creating a triangular space where the aneurysm can protrude, giving place to a remnant that can lead to a future recurrence and rebleeding. We show two cases of ruptured MCA aneurysms in which a cross-clipping technique occluded a broad base and dysmorphic aneurysm using straight fenestrated clips.
In both cases (one using a Yasargil clip and the other with a Sugita clip), a small remnant was visualized when fluorescein videoangiography (FL-VAG) was used. In both cases, the small remnant was clipped with a 3 mm straight miniclip.
We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm's neck.
大脑中动脉（MCA）是脑动脉瘤的常见部位，82.6%的动脉瘤发生在分叉处。当选择手术作为治疗方案时，旨在完全夹闭动脉瘤颈部，因为若有残余部分，在短期或长期内存在瘤体再生长和出血的可能性。
我们分析了Yasargil型和Sugita型开窗夹在特定点完全夹闭颈部的一个缺点，该特定点由开窗与夹片的结合形成，会产生一个三角形空间，动脉瘤可能会突出于此，从而留下残余部分，这可能导致未来复发和再出血。我们展示了两例大脑中动脉动脉瘤破裂的病例，其中采用交叉夹闭技术，使用直型开窗夹夹闭宽基底和形态异常的动脉瘤。
在两例病例中（一例使用Yasargil夹，另一例使用Sugita夹），使用荧光素视频血管造影（FL-VAG）时均可见小的残余部分。在两例病例中，均用3毫米直型微型夹夹闭了小的残余部分。
使用开窗夹夹闭动脉瘤时，我们应意识到这一缺点，以确保完全闭塞动脉瘤颈部。
