The Neurosurgical Atlas

The Sundt-Kees clip graft can be difficult to maneuver, and matching the size imperfectly will occlude perforators or adjacent branches, making it less effective than the cotton-clipping technique Learn more here: https://zurl.co/7g0jh

The image shows cotton-clipping technique for an anterior communicating artery aneurysm. If tearing occurs at the aneurysm neck, why is the Sundt-Kees clip graft considered inferior to the cotton-clipping technique?

The most effective method is cotton-clipping technique. The bleeding site is covered with a piece of cotton. A clip is placed across it as shown in the image, allowing the cotton to act as a bolster to seal the tear. Learn more here: https://zurl.co/GGHqM

Tearing at the aneurysm neck poses a significant challenge, as attempts to place a clip more proximally can result in narrowing or occlusion of the parent vessel. What is the most effective technique for managing this complication?

Research is vital in modern neurosurgery, covering fields like neuroscience and clinical trials. Doing research during med school is common among neurosurgery applicants, boosting profiles with experiences and publications. Learn more | https://zurl.co/7K4aM

Most IORs occur at the aneurysm dome, with the most dangerous tear at the neck. This often results from a neck fracture at the level of an atheroma or the tips of the blades penetrating the neck during blind clipping. Learn more here: https://zurl.co/cZQIP

The incidence of IOR has been reported in 7% to 35% of cases. IORs most commonly originate from which part of the aneurysm, and what is the most dangerous situation?

In this operative video, Dr. Cohen demonstrates resection of a craniopharyngioma using the endoscopic transnasal transtuberculum approach. The tumor, partially calcified and consistent with a craniopharyngioma, is carefully dissected while preserving perforating vessels to the chiasm. Using an angled curette, the tumor is mobilized, and its capsule is opened for debulking with pituitary rongeurs, facilitating gentle mobilization. The capsule is then dissected from the left optic radiations, revealing an opening into the third ventricle. The hypothalamus is protected, with only the tumor-affected portion removed. Aggressive pulling is avoided. The final piece, adherent to optic radiations, is carefully dissected and removed piecemeal, ensuring the perforating vessels remain intact while preserving vital structures. Learn more here: https://zurl.co/KwCjo

This commonly occurs in the PCoA aneurysms. In this sketch, the distal atheroma prevents approximation of the clip blades. Placement of the second tandem clip short of the atheroma can collapse the neck. Learn more here: https://zurl.co/dMxa8

Partial closure of the clip blades can be caused by atherosclerosis at the neck or perpendicular rather than parallel (to the parent vessel) clip application. This technical error most commonly occurs for aneurysms in what artery?