Aneurysm rupture caused by the aneurysm clip dislodging from the clip applier: A surgical video on the management of a known hazard for vascular neurosurgeons

Abstract

Introduction: To safely perform the clipping procedure, surgeons must familiarize themselves with correct handling of the instruments. If the clip is not properly loaded or fully inserted in the jaws of the applier, the clipping procedure may cause aneurysmal laceration. Case illustration: A 49-year-old man presented with severe headache and was admitted to another hospital. The patient underwent clipping surgery at that hospital by the author (H.K.), because patient transfer to our hospital carried the risk of aneurysm rupture caused by unstable blood pressure. The condition of the clip and applier was not confirmed by the surgeon before using it. When the surgeon brought the clip close to the aneurysm and opened the clip blade, the clip suddenly and forcefully popped out from the applier immediately and hit the aneurysm dome, resulting in rupture of the aneurysm. Conclusion: This accidental phenomenon is rare but dangerous. Vascular neurosurgeons must always be aware of the importance of the clip being accurately seated in the applier.

Keywords

• Cerebral aneurysm
• Clip
• Applier