J Neurol Surg A Cent Eur Neurosurg 2022; 83(05): 481-485
DOI: 10.1055/s-0041-1740378
Technical Note

Insufficient Closing Forces of Yasargil Titanium Clips in Two Small Aneurysms Detected with Intraoperative Indocyanine Green Videoangiography

Christian Scheller
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Julian Prell
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Sebastian Simmermacher
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Christian Strauss
1   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Christian Doenitz
2   Department of Neurosurgery, University of Regensburg, Regensburg, Germany
,
Nils Ole Schmidt
2   Department of Neurosurgery, University of Regensburg, Regensburg, Germany
,
Karl-Michael Schebesch
2   Department of Neurosurgery, University of Regensburg, Regensburg, Germany
› Author Affiliations

Abstract

Background and Study Aims Aneurysm clips must have adequate closing forces because residual blood flow in clipped aneurysms may result in aneurysm recurrence. Such flow can be intraoperatively detected by visual inspection, microvascular Doppler sonography, indocyanine green videoangiography (ICG-V), angiography, and puncture.

Patients We present two patients with ruptured very small middle cerebral artery aneurysms (3 and 2.9 mm). The necks of both aneurysms were microsurgically clipped with Yasargil aneurysm clips without any complications.

Results In both aneurysms, visual inspection suggested complete occlusion, but ICG-V showed persistent residual blood flow between the middle parts of the clip blades.

The first patient was treated with a 5.4-mm FT744T clip (closing force of 1.47 N). After the ICG-V finding, a second 3.9-mm FT714T clip (closing force of 1.08 N) was placed on the tips of the already implanted clip to increase the closing forces. Subsequent ICG-V did not show any further residual blood flow. In the second patient, the aneurysm was clipped with an 8.0-mm FE764K clip (closing force of 1.77 N). Intraoperative ICG-V showed persistent residual blood flow within the aneurysmal dome despite complete closure of the clip. The clip was repositioned closer to the parent vessel. Consecutive ICG-V did not show any residual blood flow.

Conclusion Visually undetected incomplete aneurysm occlusion can be revealed with ICG-V. In very small aneurysms, standard closing forces of clips may not be sufficient and complete closure of the clip branches should be intraoperatively validated with ICG-V.

Compliance with Ethical Standards

The investigation was approved by the ethics committee of the university.


Patient Consent

All patients granted informed consent.




Publication History

Received: 22 March 2021

Accepted: 15 September 2021

Article published online:
08 June 2022

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