Fenestrated Mini-Clip Application to Preserve a Tightly Adhering Branch Artery to a Middle Cerebral Artery Aneurysm: Technical Case Report

Abstract

Fenestrated mini-clips have been reported as useful for treating dog ear-shaped remnant aneurysms, the small aneurysms to which the efferent artery adheres or is impeded by the surrounding neurovascular structure in the restricted operative corridor, because of the smaller clip head. Here, the alternative utility of fenestrated mini-clip was reported by mentioning the narrower clip blade. We report a case of middle cerebral artery aneurysm tightly adhered by the anterior temporal artery (ATA) as well as the efferent arteries and demonstrate the utility of fenestrated mini-clip. During aneurysm dissection, the superior division of the M2 segment of the middle cerebral artery and the ATA adhered tightly to the aneurysm, thereby restricting meticulous aneurysm dissection. To preserve the efferent artery and the ATA, a fenestrated standard clip was applied, transmitting the efferent artery, and the clip blade was applied in the restricted space between the adhering ATA and the aneurysm neck. However, because kinking of the ATA was observed following first clip application, the fenestrated mini-clip was applied in similar fashion to avoid kinking of the ATA instead of a standard clip, thereby preserving the ATA without further aneurysm dissection. Finally, successful obliteration of the aneurysm and preservation of the ATA were achieved with the subsequent clip application. In selected cases, application of a narrower bladed fenestrated mini-clip in the restricted space may be useful to preserve tightly adhering branch arteries, as well as efferent arteries.