{"id":"55afd2dd-e871-448a-9f54-c442d4dee945","slug":"limitation-of-fenestrated-clips-during-clipping-of-middle-cerebral-artery-aneurysm-technical-note","title":"Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note","authors":["Javier Degollado-García","Héctor A. Rodríguez-Rubio","Alfredo Bonilla-Suastegui","Alejandro Serrano-Rubio","Carlos F. Nicolas-Cruz","Edgar Nathal"],"abstract":"Background: 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. Methods: 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. Results: 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. Conclusion: We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm’s neck.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/55afd2dd-e871-448a-9f54-c442d4dee945/featured/hero-1781560242695.png","publishDate":"2023-06-16T00:00:00.000Z","doi":"10.25259/SNI_374_2023","categories":["Neurovascular","Technical Note"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2023/06/12368/SNI-14-204.pdf"}