Temporary Clip Application
Temporary clip ligation is no longer a last-resort approach only for controlling intraoperative rupture. In fact, I have a low threshold for using short periods of proximal arterial occlusion to decrease the turgor of the aneurysm; this maneuver significantly facilitates neck dissection, resulting in a very efficient and desirable clip construct of the afferent and efferent vessels while salvaging the perforating vessels.
After the initial stages of dissection and preliminary aneurysm neck exposure, the final dissection of the aneurysm and subsequent clip deployment is in order. From this point, the surgeon may proceed in one of two ways.
At times, immediate final neck dissection and permanent clip ligation is undertaken. For small, unruptured, narrow neck, well-visualized aneurysms requiring minimal dissection, this approach is ideal. In most other situations—broad neck and complex aneurysms requiring significant dissection—I prefer to facilitate permanent clipping through the use of partial regional temporary circulatory arrest (temporary clipping of the proximal aspec...