Repair of a Tear at the Base of an Aneurysm During Microsurgical Clipping of Ruptured Cerebral Aneurysm.

Aneurysms can produce large defects in the parent vessel if the aneurysm tears at the neck of the vessel. We present techniques used to repair a tear at the base of an aneurysm encountered during microsurgical clipping of a ruptured aneurysm. The repair technique involved suturing and covering the aneurysm with an encircling aneurysm clip. A large tear had destroyed the vessel's tubular structure and therefore an encircling clip alone was insufficient for repair. Two microsuture stitches were placed on the tear, so that a split artery reformed a tubular structure. The temporary clip on the distal internal carotid artery was removed for a moment, allowing the retrograde blood flow to provide the counterforce necessary to maintain the vessel's tubular structure. An encircling clip was then applied to cover the entire circumference of the lesion. Another technique involved placing needles over a tear and applying clips while avoiding parent artery stenosis. Placing a clip to cover an entire tear resulted in an arterial stenosis but just applying a clip was insufficient for repair. With this guiding needle method, a clip can adequately be placed without parent artery stenosis. These methods required only a short occlusion time for arterial repair, thus helping avoid ischemic complications. These techniques are useful for repairing an aneurysmal tear at its base, especially if the tear is large.