New aneurysm clip and applier for narrow spaces: Technical note

OBJECTIVE: Aneurysm surgery carries considerable risk to the patient, in pa rt because the surgical field can be so constricted that accurate placement of the aneurysm clip is impeded. In fact, most aneurysm clip appliers are so bulky that they can impair the surgeon's view, if the field is tight. We describe a system of aneurysm clips and appliers that have a very low prof ile and consequently allow better visualization of the operative field at c ritical moments during surgery. INSTRUMENTATION: A new system of clips for aneurysm surgery was developed t o overcome some of the deficiencies of conventional sets. The new clip blad es ave opened from inside the spring, so the clip blades are clearly seen a s they are applied across the base of the aneurysm. In addition, these clip s can be angled in any desired direction in the applier, which makes their application easier. A third advantage is that the clip applier is used as a clip remover should adjustment or reapplication of the clip be necessary. RESULTS: Thirty aneurysms were obliterated with the new clips without any c omplications attributable to the clips. The new instruments allowed the saf e application of clips to aneurysms in deep, confined, and anatomically com plex spaces, such as aneurysms of the basilar tip and anterior communicatin g artery. CONCLUSION: The newly described system of aneurysm clips and appliers appea rs to have significant advantages over other currently available systems.