title: Double-clip technique for the microneurosurgical management of very small (< 3 mm) intracranial aneurysms.
abstract: BACKGROUND
  The treatment of very small (≤ 3 mm) aneurysms is technically challenging. Mini-clips used for clipping these small aneurysms have a smaller closing force compared with standard clips.
  
  
  OBJECTIVE
  To describe the double-clip technique for very small aneurysms.
  
  
  METHODS
  The double-clip technique, a parallel duplication clipping technique of booster clipping, is used by the senior author for clipping very small aneurysms with morphology suitable for the application of 2 clips. The aneurysm is clipped after application of temporary clip(s), administration of adenosine, or both. An initial mini-clip is applied, leaving a small residual neck sufficient for application of the second mini-clip. A second mini-clip of the same size and shape is applied on the residual neck parallel to the initial clip. The initially applied mini-clip, which is in close contact with the second clip, supports the second clip and prevents its slippage. This technique was retrospectively reviewed over a 13-year period (1997-2009). There were 3246 patients with 4757 aneurysms treated in the same period.
  
  
  RESULTS
  The outcomes of 39 patients with 40 very small aneurysms clipped with the double-clip technique were analyzed. None of the patients had technique-related complications. Postoperative angiograms revealed complete aneurysm occlusion of 39 aneurysms and a small residual neck in 1 aneurysm. No parent artery obstruction was observed in the postoperative angiogram.
  
  
  CONCLUSIONS
  The double-clip technique is a safe and effective variation of booster clipping in the treatment of very small aneurysms with suitable morphology.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Narayanam Anantha Sai
authors.initials: NA
authors.lastname: Kiran
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.forename: Joham Choque
authors.initials: JC
authors.lastname: Velasquez
authors.forename: Ferzat
authors.initials: F
authors.lastname: Hijazy
authors.forename: Felix
authors.initials: F
authors.lastname: Goehre
authors.forename: Riku
authors.initials: R
authors.lastname: Kivisaari
authors.forename: Chaiyot
authors.initials: C
authors.lastname: Siangprasertkij
authors.forename: Luis Francisco
authors.initials: LF
authors.lastname: Munoz Gallegos
authors.forename: Hanna
authors.initials: H
authors.lastname: Lehto
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D055815:Young Adult