Dural adhesion as a cause of late clip slippage from the medial cerebral artery aneurysm

• Autorzy: Szmuda T. , Sloniewski P.
• Języki publikacji: EN

Abstrakty

EN

Background: A properly placed clip may slip off the aneurysm during the postoperative period. Many factors have been attributed to this complication, although clip adherence to the dural stitch has not been reported. Materials and methods: Following the single occurrence of such unusual complication, 64 similar medial cerebral artery (MCA) aneurysms were retrospectively investigated at a single institution. Clip adherence to the dura demonstrated in early postoperative computed tomography (CT) was a presumed factor of a late clip migration in this study. Results: In the series, there were 4 (6.3%) aneurysm remnants and 1 slipped clip that firmly adhered to the dura. In this particular case, the revision surgery revealed the spring coil firmly adhering to the dura in the previous suture line. Neither the occurrence of an aneurysm neck remnant nor clip slippage were related to the clip’s adherence to the dura in the analysis of the entire group (p > 0.05). On the contrary, application of a fenestrated clip did contribute to that finding in multivariate analysis (p < 0.01). Unlike the rest, two surgeons unintentionally tended to position the clip close to the dura (p < 0.01). The clip-to-dura distance measured in the follow-up CT angiography 1 year after the surgery differed from that in the postoperative CT in 83.8% of the cases and decreased by an average of 0.5 mm. Conclusions: Clip-to-dura adherence should be regarded as a normal finding in the postoperative CT following MCA aneurysm clipping. Surgeons should consider the possibility of clip head protrusion into the dural stitch line. (Folia Morphol 2019; 78, 3: 501–507)

• Wydawca: -
• Czasopismo: Folia Morphologica
• Rocznik: 2019
• Tom: 78
• Numer: 3
• Opis fizyczny: p.501–507,fig.,ref.

Twórcy

autor

Szmuda T.

• Neurosurgery Department, Medical University of Gdansk, Debinki 7, 80–952 Gdansk, Poland

autor

Sloniewski P.

• Neurosurgery Department, Medical University of Gdansk, Debinki 7, 80–952 Gdansk, Poland

Bibliografia

• 1. Apuzzo MLJ. Brain surgery: complication avoidance and management. Churchill Livingstone. 1993: 988.
• 2. Asgari S, Wanke I, Schoch B, et al. Recurrent hemorrhage after initially complete occlusion of intracranial aneurysms. Neurosurg Rev. S. Asgari, Department of Neurosurgery, University Hospital, 45147 Essen, Germany. 2003; 26(4): 269–274.
• 3. Beltagy M, Muroi C, Roth P, et al. Recurrent intracranial aneurysms after successful neck clipping. World Neurosurg. 2010; 74(4-5): 472–477, doi: 10.1016/j.wneu.2010.06.036, indexed in Pubmed: 21492597.
• 4. Carvi y Nievas MN, Höllerhage HG. Risk of intraoperative aneurysm clip slippage: a new experience with titanium clips. J Neurosurg. 2000; 92(3): 478–480, doi: 10.3171/jns.2000.92.3.0478, indexed in Pubmed: 10701539.
• 5. Carvi y Nievas MN. Assessment of the clipping efficacy of intracranial aneurysms: analysis of the employed methodology in relation to case difficulty. Neurol Res. 2007; 29(5): 506–516, doi: 10.1179/016164107X164148, indexed in Pubmed: 17535574.
• 6. Diraz A, Kyoshima K, Kobayashi S. Dorsal internal carotid artery aneurysm: classification, pathogenesis, and surgical considerations. Neurosurg Rev. 1993; 16(3): 197–204, indexed in Pubmed: 8272208.
• 7. Drake CG, Allcock JM. Postoperative angiography and the “slipped” clip. J Neurosurg. 1973; 39(6): 683–689, doi: 10.3171/jns.1973.39.6.0683, indexed in Pubmed: 4759655.
• 8. Drake C, Peerless S, Hernesniemi J. Surgery of vertebrobasilar aneurysms. Vienna: Springer. 1996.
• 9. Drake CG, Vanderlinden RG. The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg. 1967; 27(3): 226–238, doi: 10.3171/jns.1967.27.3.0226, indexed in Pubmed: 6047996.
• 10. Giannotta SL, Litofsky NS. Reoperative management of intracranial aneurysms. J Neurosurg. 1995; 83(3): 387–393, doi: 10.3171/jns.1995.83.3.0387, indexed in Pubmed: 7666212.
• 11. Giannotta S. Complication Avoidance for Large and Giant Carotid Ophthalmic Aneurysms. New Trends in Management of Cerebro-Vascular Malformations. Pasqualin A, Da Pian R, editors. Vienna: Springer. 1994: 198–202, doi: 10.1007/978-3-7091-9330-3_36.
• 12. Hayashi Y, Kimura M, Satake R, et al. Possible participation of clip rotation in the formation of de novo aneurysm. J Clin Neurosci. 2004; 11(3): 331–334, doi: 10.1016/S0967-5868(03)00199-1, indexed in Pubmed: 14975434.
• 13. Horiuchi T, Li Y, Seguchi T, et al. Clip blade scissoring with titanium bayonet clip in aneurysm surgery. Two case reports. Neurol Med Chir (Tokyo). 2012; 52(2): 84–86, doi: 10.2176/nmc.52.84, indexed in Pubmed: 22362289.
• 14. Kariyattil R, Panikar D. Scissoring of a Cobalt Alloy Aneurysm Clip causing Slippage during Cerebral Aneurysm Surgery: Case report and review of literature. Sultan Qaboos Univ Med J. 2013; 13(1): 179–182, indexed in Pubmed: 23573404.
• 15. Kataoka K, Arita N, Yamada Y, et al. Clipping techniques for the juxta-dural ring aneurysms. Surg Cereb Stroke. 1995; 23(1): 55–60, doi: 10.2335/scs1987.23.1_55.
• 16. Kim YH, Kim JE, Kang HS, et al. Migration of an aneurysm clip to the sacral subarachnoid space. Acta Neurochir (Wien). 2009; 151(6): 699–700, doi: 10.1007/s00701-009-0260-2, indexed in Pubmed: 19277456.
• 17. McKissock W. Recurrence of an intracranial aneurysm after excision. J Neurosurg. 1965; 23(5): 547–548, doi: 10.3171/jns.1965.23.5.0547, indexed in Pubmed: 5858447.
• 18. Mortazavi M, Ravanpay A, Sekhar L. Clipopexy: an anchoring technique to avoid compression of adjacent neurovascular structures by aneurysm clip: report of two cases. Cureus. 2014, doi: 10.7759/cureus.168.
• 19. Nakamura K, Kitabayashi M, Murata T. Clipping for Wide-necked Asymptomatic Unruptured Intracranial Aneurysm. Surg Cereb Stroke. 2012; 40(4): 251–256, doi: 10.2335/scs.40.251.
• 20. Oyesiku NM, Jones RK. Migration of a Heifetz aneurysm clip to the cauda equina causing lumbar radiculopathy. Case report. J Neurosurg. 1986; 65(2): 256–257, doi: 10.3171/jns.1986.65.2.0256, indexed in Pubmed: 2941527.
• 21. Park CK, Shin HS, Choi SK, et al. Clinical analysis and surgical considerations of atherosclerotic cerebral aneurysms: experience of a single center. J Cerebrovasc Endovasc Neurosurg. 2014; 16(3): 247–253, doi: 10.7461/jcen.2014.16.3.247, indexed in Pubmed: 25340027.
• 22. Sato S, Suzuki J. Prognosis in cases of intracranial aneurysm after incomplete direct operations. Acta Neurochir (Wien). 1971; 24(4): 245–252, indexed in Pubmed: 5132408.
• 23. Szmuda T, Sloniewski P. Giant intracranial aneurysms — surgical treatment, accessory techniques and outcome. In: Murai Y, editor. Aneurysm. InTech. 2012. : 351–382.
• 24. Uemura T. Treatment of a postoperative iatrogenic aneurysm following repeated temporary clipping procedures and pitfalls of the angled fenestrated clip application. Surg Cereb Stroke. 1987; 15(3): 271–274, doi: 10.2335/scs1987.15.3_271.
• 25. Wester K. Lessons learned by personal failures in aneurysm surgery: what went wrong, and why? Acta Neurochir (Wien). 2009; 151(9): 1013–1024, doi: 10.1007/s00701-009-0452-9, indexed in Pubmed: 19609480.

Identyfikatory

DOI

10.5603/FM.a2019.0003