title: The new aneurysm clip system for particularly complex aneurysm surgery: technical note.
abstract: BACKGROUND
  Currently, there is an ongoing debate regarding the best treatment option for ruptured aneurysms. The International Subarachnoid Aneurysm Trial study suggests that an endovascular procedure is the best treatment. In some complex cases, or in patients with an additional large intracerebral hemorrhage, aneurysms require further microsurgical clipping.
  
  
  OBJECTIVE
  We introduce a new clip system to improve clipping procedures in especially complex aneurysms.
  
  
  METHODS
  The inverted opening mechanism of the clip in combination with the special clip applier provides the surgeon with a good overview in the operating field. The new design also enables a wider opening of the clip jaws in contrast to all other well-known titanium aneurysm clips. This should provide a better and safer application and decrease the danger of premature rupture.
  
  
  RESULTS
  From January 2006 to July 2008, 55 aneurysms were clipped in 45 patients. The most common aneurysm location was the anterior communicating artery (20 patients) followed by the M1 segment of the middle cerebral artery (16 patients). Four patients had 2, one had 3, and one had 5 aneurysms. Two clipping procedures were performed for an arteriovenous malformation-associated aneurysm. All aneurysms were clipped without any technical complication.
  
  
  CONCLUSIONS
  The use of the new clip system, especially in complex aneurysm surgery, has potential benefits because of the better surgical vision during clip application and the wider opening of the clip jaws. It is easy to handle and compatible with magnetic resonance imaging.
authors.affiliation: Department of Neurosurgery, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich, Germany.
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Krammer
authors.forename: Christianto B
authors.initials: CB
authors.lastname: Lumenta
mesh_terms: D000328:Adult; D000368:Aged; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D013525:Surgical Instruments / Q000592:standards* / Q000639:trends*; D014025:Titanium / Q000592:standards / Q000627:therapeutic use; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods
chemical_list: D014025:Titanium