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.

Middle Cerebral Artery Aneurysm “Neck Overhang”: Decreased Postclipping Residual Using the Intersecting Clipping Technique

“…2,11,12,[16][17][18][19] Outflow vessel size and orientation and neck anatomy can be variable and complex and thus lead to several standardized approaches to clipping based on morphological characteristics. 2,12,16,17,[29][30][31] Our data suggest that another feature that leads to significant complexity of safe treatment is the amount of aneurysm that extends proximal to the 2 dimensionally defined neck. In aneurysms with large neck overhang, any clipping strategy that places a clip parallel to the outflow vessels further widens the splayed bifurcation and risks kinking or stenosis of these vessels (see Figure 5).…”

“…The concept of the optimum clipping technique has been studied based on the morphological features of the aneurysm neck, the anatomical variations of the branches in relation with the aneurysm neck, and the ideal closure line for each aneurysm. 12,[29][30][31]…”