Abstract
Background
One of the most difficult procedures through a deep and narrow surgical corridor is tying a knot following microsuturing, even though microvascular suturing is a fundamental technique for neurovascular surgeons.
Methods
A novel technique replacing the conventional knot-tying method was devised. The proposed clip-knotting technique uses an aneurysm clip to hold both remaining ends of a thread that is sutured in a running manner.
Conclusions
The proposed clip-knotting technique can facilitate the microsuturing procedure for intracranial arterial repair in a deep and narrow operative field.
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References
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Conflicts of interest
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Disclosure
The author reports no conflict of interest concerning the materials or methods used in this study or the findings.
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Key points
1. The clip-knotting technique is useful in minimally invasive surgery including a superciliary keyhole approach.
2. Tying a knot following microsuturing is difficult in a deep and narrow operative field.
3. It can be replaced by the proposed clip-knotting technique.
4. This is applied for intracranial arterial repair.
5. A needle with a short (5-cm) thread is used.
6. Microvascular suturing is performed in a running manner.
7. The running stitch is pulled tight to approximate the edges of the arterial lesion.
8. An aneurysm clip is applied to hold both threads in place.
9. The closing power of an aneurysm clip to hold a suture without slippage can be checked using mosquito forceps.
10. Postoperative and follow-up angiograms are required.
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Park, J. Clip-knotting technique for intracranial arterial suturing through deep and narrow surgical corridors—how I do it. Acta Neurochir 157, 769–771 (2015). https://doi.org/10.1007/s00701-015-2350-7
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DOI: https://doi.org/10.1007/s00701-015-2350-7