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How I do it: coil extraction and clip reconstruction of a previously coiled giant middle cerebral artery aneurysm

  • How I Do it - Vascular Neurosurgery - Aneurysm
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Abstract

Background

Microsurgical clipping of previously coiled intracranial aneurysms can be technically challenging. We present the case of a 48-year-old female with a partially coiled, previously ruptured giant middle cerebral artery aneurysm and the associated technical nuances.

Methods

We performed a successful coil extraction and clip reconstruction of this aneurysm using an ultrasonic aspirator and stacked fenestrated aneurysm clips.

Conclusion

Coil extraction and clip occlusion of previously coiled intracranial aneurysms is a complex and technically challenging procedure but can be performed safely and effectively when employed judiciously.

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Author information

Authors and Affiliations

  1. Manchester Centre for Clinical Neurosciences, Manchester, UK

    Cathal John Hannan

  2. National Neurosurgical Centre, Beaumont Hospital, Beaumont Road, Dublin, Ireland

    Mohsen Javadpour

  3. Royal College of Surgeons in Ireland, Dublin, Ireland

    Mohsen Javadpour

  4. School of Medicine, Trinity College Dublin, Dublin, Ireland

    Mohsen Javadpour

Authors
  1. Cathal John Hannan
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  2. Mohsen Javadpour
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Corresponding author

Correspondence to Mohsen Javadpour.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Key Points

• During the approach to complex, previously coiled MCA aneurysms, be cognisant of the potential requirement for an EC-IC bypass and preserve the superficial temporal artery

• Opening of the aneurysm and coil extraction should only be attempted when attempts at simple clip application have failed

• The ultrasonic aspirator is a useful tool for breakdown of thrombus and coils and facilitating extraction of the coils

• Delay temporary clip application until most of the thrombus and coils have been extracted to limit temporary clipping time

• Stacked fenestrated clips are useful in the occlusion of thick-walled aneurysms, which may cause splaying of the blades of non-fenestrated clips and allow ongoing aneurysm filling

• Indocyanine green angiography is essential in order to confirm the patency of the MCA branches.

• Complex MCA aneurysms have high rates of recurrence following endovascular treatment, and surgical intervention should be considered as a primary treatment modality in these cases

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Hannan, C.J., Javadpour, M. How I do it: coil extraction and clip reconstruction of a previously coiled giant middle cerebral artery aneurysm. Acta Neurochir 163, 2363–2366 (2021). https://doi.org/10.1007/s00701-021-04727-0

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  • DOI: https://doi.org/10.1007/s00701-021-04727-0

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