title: Utility of crankshaft clips for middle cerebral artery aneurysms: A single-center experience of 150 cases.
abstract: BACKGROUND
  Applying more than one clip for a complicated-shaped aneurysm is an established strategy, particularly for middle cerebral arteries (MCA). However, obliterating the cleft of the internal elastic lamina with a single clip is theoretically possible because the line is usually on a single plane. Crankshaft clips were reformed for that purpose decades ago, but are not widely used and have been described in almost no report ever since.
  
  
  METHODS
  To reconsider and describe the utility of crankshaft clips for complicated MCA aneurysms and to articulate the advantages and limitations of the clips, we meticulously analyzed a series of more than 150 cases in which the crankshaft clips were used, predominantly for treatment of MCA aneurysms, at Moriyama Memorial Hospital between August 2010 and December 2015.
  
  
  RESULTS
  Readjustment of the clip was not necessary in almost all cases, and the first application was the final one. None of the patients had morbidity or mortality related to the surgical technique. To date, we have not experienced any trouble or recurrence.
  
  
  CONCLUSIONS
  Crankshaft clips are useful and safe for clipping of complicated MCA aneurysms.
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Atsushi
authors: A
authors: Ishida
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Seigo
authors: S
authors: Matsuo
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Keizoh
authors: K
authors: Asakuno
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Akio
authors: A
authors: Nemoto
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Kaku
authors: K
authors: Niimura
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Haruko
authors: H
authors: Yoshimoto
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Hideki
authors: H
authors: Shiramizu
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Ryu
authors: R
authors: Ubagai
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Miki
authors: M
authors: Yuzawa
authors: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
authors: Tomokatsu
authors: T
authors: Hori
keywords: Crankshaft clip; closure line; middle cerebral aneurysm; multiple clipping