Clipping Strategies and Intraoperative Tools to Detect Aneurysm Obliteration and Cerebral Vessel Patency

Abstract

Cerebral aneurysms are common cerebrovascular diseases most frequently manifest with vascular rupture and subsequent subarachnoid hemorrhage. Microsurgical clipping is considered the best long-term treatment, despite of the increase of endovascular interventional treatments in the latest years. Vascular control is a pivotal concept for aneurysms surgery, which provides the application of temporary clip in case of rupture, whereas the application of permanent clip requires the perfect knowledge of aneurysm anatomy. Several techniques to obtain the obliteration of the aneurysm while preserving the parent vessels and its branches have been described. Micro-Doppler ultrasonography (MUSG), indocyanine green video angiography (ICG-VA), and electrophysiological neuromonitoring (IONM) are all useful intraoperative tools, which can improve the safety of surgical procedures and achieve the goal of aneurysm obliteration with parent vessel and perforating preservation.