Microsurgical Aneurysm Clipping
Aneurysm clipping is an open microsurgical procedure in which a small titanium clip is placed across the neck of a brain aneurysm to exclude it from the circulation. It is a durable treatment option that aims to prevent rebleeding while preserving blood flow in the parent artery.
마지막 업데이트: 2026-06-08
Definition
Aneurysm clipping is a microsurgical procedure performed under the operating microscope, reaching the brain through a craniotomy (temporary removal of a bone flap from the skull). The neck of the aneurysm is dissected and freed, and a spring-loaded titanium clip is applied across it. The clip separates the aneurysm sac from the parent-vessel circulation and stops blood from entering it. The sac then thromboses over time, and the risk of rupture is eliminated.
Indications
Clipping can be used for both ruptured aneurysms (those causing subarachnoid hemorrhage) and selected unruptured intracranial aneurysms. It is often preferred for wide-necked aneurysms, those incorporating branches, or anatomies unfavorable for endovascular coiling. It is also valuable in younger patients and when an accompanying intracerebral hematoma needs to be evacuated. For unruptured aneurysms, the decision is individualized by balancing rupture risk against surgical risk.
Method
The procedure is performed under general anesthesia. A craniotomy appropriate to the aneurysm location is created; one of the most common routes is the pterional approach. The aneurysm is reached by gently opening natural arachnoid spaces (cisterns) rather than relying on brain retraction. After the parent artery and its branches are identified and protected, a clip is placed across the aneurysm neck. Intraoperative angiography, indocyanine-green videoangiography or micro-Doppler is used to confirm correct clip placement and preserved parent-vessel flow.
Advantages and Limitations
Clipping provides a robust and usually permanent occlusion; the long-term need for retreatment tends to be lower than with endovascular methods. It allows evacuation of an accompanying hematoma in the same session. On the other hand, as an open operation it is more invasive, recovery is longer, and it can be technically demanding for deep-seated or posterior-circulation aneurysms. The choice between clipping and endovascular treatment depends on aneurysm anatomy and patient-specific factors.
Recovery and Risks
After surgery, patients are usually monitored in intensive care for a period; recovery time depends on whether the aneurysm had ruptured and on the overall condition. Potential risks include intraoperative bleeding, stroke, seizures, infection, narrowing of the parent artery and anesthesia-related complications. In ruptured cases, additional problems such as vasospasm and hydrocephalus may occur. No outcome is guaranteed; decisions are individualized.
참고 문헌
- Lawton MT. Seven Aneurysms: Tenets and Techniques for Clipping. Thieme; 2011:13-26.
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1457-1462.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011.
- Molyneux A, et al. International Subarachnoid Aneurysm Trial (ISAT): clipping versus coiling. Lancet. 2002.
이 항목은 일반적인 안내 목적이며 의사의 진료를 대신하지 않습니다. 진단과 치료 결정은 개인별로 이루어집니다.