A combined surgical-endovascular device concept for giant aneurysm neck occlusion.

PURPOSE: In this report, we describe a new multimodality device concept for occluding giant aneurysms. The device is designed to exploit the advantages, and avoid the disadvantages, of conventional microneurosurgery and interventional neuroradiology methods. CONCEPT: Our device concept involves surgically placing small permanent magnets, incorporated into a partially occluded magnetic clip, about the extraluminal neck without mechanically compromising the perforating vessels. These magnets serve as optimally positioned anchor points for ferromagnetic materials subsequently introduced via the endovascular route. RATIONALE: Currently, neurosurgical extraluminal obliteration of giant aneurysms is achieved by mechanically closing the aneurysm neck with metal clip blades, which is a technique that risks inadvertent occlusion of critical perforating vessels. Perforating vessel strokes can largely be avoided using endovascular aneurysm occlusion methods. However, in the setting of the giant aneurysm, these endovascular techniques are associated with high rates of incomplete occlusion. DISCUSSION: Preliminary feasibility tests of this concept were conducted using a simple prototype constructed in our laboratories.