Use of a new aneurysm clip with an inverted-spring mechanism to facilitate visual control during clip application

Abstract

When operating on deep-seated cerebral aneurysms, the surgeon's visual control of clip application may be impaired by the clip holder unless adjacent structures are retracted. To improve visual control and reduce the necessity for retraction, the senior author (A.P.) developed a new concept: an aneurysm clip with an inverted-spring mechanism. The clip has two jaws that point away from the clip blades. The jaws of the clip holder articulate with the inner side of the clip jaws. By distending the jaws of the clip holder the blades of the clip are opened and vice versa. Thus the visual field increases while the clip application is proceeding. This instrumentation is useful, especially in cases of deep-seated aneurysms arising from the posterior circulation and in multiple aneurysms. In these latter cases even lesions located contralaterally could be reached with good visual control.

Supraorbital eyebrow approach to skull base lesions

“…Recently, Perneczky et al [10][11][12] , developed several endoscopic supraorbital approaches (key-hole surgery) and designed a new aneurysm clip with an inverted-spring to facilitate visual control during aneurysm surgery. They also describe the use of this approach to treat 197 aneurysms.…”

“…Usually tumors, aneurysms, and other lesions situated in the anterior or middle cranial fossae are approached by the standard classic pterional craniotomy [1][2][3] . Some other new techniques are also used to approach the orbit, anterior fossa and skull base 4-9 .Recently Perneczky et al [10][11][12] have developed several supraorbital endoscopic "key-hole" approaches and demonstrated a good visualization of the socalled "suprasellar virtual pyramid". Combination of endoscopy and microneurosurgery permits the reduction of the size of the craniotomy required for good visualization of tumor or aneurysm and surrounding structures if compared to traditional techniques.…”

“…Recently Perneczky et al [10][11][12] have developed several supraorbital endoscopic "key-hole" approaches and demonstrated a good visualization of the socalled "suprasellar virtual pyramid". Combination of endoscopy and microneurosurgery permits the reduction of the size of the craniotomy required for good visualization of tumor or aneurysm and surrounding structures if compared to traditional techniques.…”

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

“…The supraorbital keyhole craniotomy via an eyebrow skin incision is well described by Perneczky et al 24,27,28) . The successful management of supratentorial aneurysms by keyhole supraorbital craniotomy has recently been reported 9,10,13,17,21,24,[26][27][28][29][30][31][32] .…”

Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors

“…The keyhole concept has been developed in the past years. 11,17,18,22 It is based on an important principle: smaller openings create a surgical field that widens as the distance from the craniotomy increases. The achievement of a smaller opening is made possible by performing the craniotomy in a strategic location that takes advantage of the regional anatomy to focus the opening on the lesion of interest.…”