2. ANEURYSM
An aneurysm is an outward bulging, likened to a bubble or balloon, caused
by a localized, abnormal, weak spot on a blood vessel wall.
An aneurysm as seen in DSA
3. BASIC TYPES OF ANEURYSMD BASED ON
LOCATION
• PCOM (Posterior Communicating artery) Aneurysm
•ACOM ( Anterior Communicating artery) Aneurysm
•MCA (Middle cerebral artery) Aneurysm
4.
5. EXTRA THINGS REQUIRED
• 1mm dissector
•Small tumour holding
•Aneurysm scissors
•Micro-byonet
•Insulin syringes
•Inj.papaverine in 5ml syringe (vasodilator- prevents vasoconstriction of vessels that happens
due to surgical manipulation)
•Small cottonoids
•Aneurysm tray ( has fine suction tips, mini and standard clip applicator,
mini and standard temporary and permanent clips)
•ICG (Indo Cyanine Green/ Aurogreen)
6. 2 TYPES OF APPLICATORS:-
1. STANDARD ( IN SIMPLE WORDS -BIGGER ONE)
2. MINI (IN SIMPLE WORDS- SMALLER ONE)
7. CLIPS USED IN NIMHANS
•Aesculap Yasargil aneurysm clips are
•non-ferromagnetic
• MRI-Safe (3-Tesla or less) implants
•crafted from Titanium
8. Silver coloued clips are the permanent clips
Golden colored clips are the temporary clips
9. 1.Standard straight clip 2. Standard curved clip 3. Standard forward angle clip
4. Standard Fenestrated clip 6. Standard fenestrated forward
angle clip
5. Standard fenestrated right
angled clip
10. CARE OF ANEURYSM APPLICATOR
•First of all differentiate between standard(for standard temporary and permanent
clips) and mini (for mini temporary and permanent clips)applicator.
•Gently handle the applicator while loading and unloading the clip as the instrument is
very delicate.
•If any defect or malfunction is found in the applicators, report it immediately to the
superiors
•After the dural closure, send the aneurysm applicators, suction tips and clips
separately.
11. BASIC PROCEDURE
oPositioning
oCraniotomy(usually Pterional) and basal drilling
oDural opening
oDissection of aneurysm
oApplication of temporary clip to the parent artery
oChecking for any rupture using dissector
oApplication of permanent clip
oAgain checking for any rupture using dissector
oPlacing gelfoam soaked in Inj. Papavarin ( size - )
oIcg for confirmation
oClosure
12. CLIPPING OF ACOM ANEURYSM
Video Link:-
https://www.youtube.com/watch?v=myOHFz5s07o
