Techniques and Methods for Safe and Effective Clipping of Aneurysmal Neck

Clipping an aneurysmal neck is considered an optimal treatment modality for ruptured and unruptured cerebral aneurysms. However, various anatomical variations in the relationships of parent artery, branched arteries, shape of the aneurysmal dome and aneurysmal neck frequently make it difficult to apply a simple clipping method using a single clip. To achieve safe and effective neck clipping, we use several techniques such as the clipping on wrapping method (COW method), tentative parallel clipping method (TPC method) and combination clipping with fenestrated clips (CCFC method). In this study, we analyzed the safety and effectiveness of these methods. In 515 surgeries for cerebral aneurysm performed between January 2001 and December 2003, the COW method, TPC method and CCFC method were used in 61 cases, 11 cases and 26 cases, respectively. In patients treated by the COW method, slight stenosis of the parent arteries was found on long-term follow-up studies in only 2 patients. In patients treated by the TPC method and/or CCFC method, complete obliteration of the aneurysm and preservation of blood flow through the parent arteries and branched arteries were confirmed. These 3 techniques are safe and effective methods for aneurysmal neck clipping.