title: Clip blade scissoring with titanium bayonet clip in aneurysm surgery. Two case reports.
abstract: Scissoring of the cerebral aneurysm clip blades is a rare but potentially devastating complication of clipping surgery and results in aneurysm neck injury inducing rupture and/or cerebral infarction. Scissoring has been reported using titanium straight clips. Here we present two unusual cases of crossing of the blades of titanium bayonet clips by a scissors-like mechanism during surgery. The present cases suggest the following points. Bayonet clips in addition to straight clips may display the scissoring phenomenon during clipping surgery. The slipped clip should be removed immediately because the scissor-like deformed aneurysm clip may slip further and result in parent artery stenosis. Scissoring tends to happen in the presence of partial arteriosclerosis of the aneurysm neck. Before a titanium clip is used to treat an aneurysm with partially arteriosclerotic neck, reducing the amount of aneurysm filling by temporary clipping of the main vessel is useful to avoid slippage phenomena.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan. tetuyosi@shinshu-u.ac.jp
authors.forename: Tetsuyoshi
authors.initials: T
authors.lastname: Horiuchi
authors.forename: Yuhui
authors.initials: Y
authors.lastname: Li
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Seguchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sato
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Aoyama
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hanaoka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hongo
mesh_terms: D000368:Aged; D004868:Equipment Failure; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011859:Radiography; D013525:Surgical Instruments / Q000009:adverse effects* / Q000592:standards; D014025:Titanium / Q000627:therapeutic use; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation*
chemical_list: D014025:Titanium