title: Inappropriate application of Yaşargil aneurysm clips: a new observation and technical remark.
abstract: OBJECTIVE
  Recurrences after complete surgical clipping of an aneurysm base are rare. We describe a potential reason for such recurrences: the inappropriate application of a popular aneurysm clip.
  
  
  METHODS
  We present 3 cases in which intraoperative indocyanine green video angiography after clipping clearly demonstrates filling of the aneurysm.
  
  
  METHODS
  During surgery, the necks of the aneurysms were clipped with Yaşargil aneurysm clips (Aesculap AG & Co., Tuttlingen, Germany) without any problems; however, indocyanine green video angiography after clipping showed filling of the aneurysms through the point located at the junction of the blade and spring portions of the clips. In the first patient, the aneurysm sac was further coagulated, and a second, smaller clip was applied to completely occlude the untreated part. In the second patient, the clip was replaced with a different clip that had longer blades. In the third patient, 2 additional clips were applied, and the aneurysm sac was also coagulated. The postoperative computed tomographic angiographic examinations showed total occlusion of the aneurysms and patency of the parent arteries. All patients achieved full recovery after the operations.
  
  
  CONCLUSIONS
  We present here, for the first time, evidence that the small orifice located at the junction of the blade and spring portions of Yaşargil aneurysm clips can lead to failure of initial surgery and/or recurrence. This can be avoided by using clips with slightly longer blades to keep the orifice away from the aneurysm or by applying a second clip to occlude the untreated part.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Ozgür
authors.initials: O
authors.lastname: Celik
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Rossana
authors.initials: R
authors.lastname: Romani
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D002533:Cerebral Angiography / Q000379:methods; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000517:prevention & control / Q000601:surgery; D013525:Surgical Instruments / Q000592:standards*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green