SUTURELESS REPAIR OF MAJOR INTRACRANIAL VESSELS WITH THE SUNDT CLIP-GRAFT - TECHNICAL NOTE

Major intracranial vessels can be damaged during tumor resection. With the availability of refined microvascular techniques, direct repair o r by-pass of the damaged segment is possible. These methods, however, often require temporary occlusion of the offending vessel, can result in a less than optimal angiographic result, and are difficult to perfo rm in a deep field. Additionally, in some patients direct repair or by -pass is not feasible because of the friability of the vessel or as a result of the large size of the tear. In these cases the Sundt clip-gr aft represents a valid adjunct to the armamentarium of the surgeon. Ov er the years, it has been used by the senior author in five patients w here vascular injury occurred during the removal of brain tumors (3 me ningiomas, one pituitary adenoma, and one low-grade glioma). In this r eport we illustrate our most recent experience with this ingenious too l. A 22-year-old man underwent resection of a recurrent left temporal lobe low-grade glioma. During resection of the tumor, a tear occurred in a branch of the middle cerebral artery. The tear was repaired using a Sundt clip-graft. A post-operative angiogram, performed five days l ater, showed patency of the vessel with no evidence of wall irregulari ties. Described 30 years ago to be used primarily in aneurysm surgery, the Sundt clip-graft provides an excellent, too often forgotten, sutu reless method of repairing intracranial vessels damaged during tumor r emoval.