Intraoperative Cerebrovascular Flow Measurement Showcased in Video Protocols

Clipping of a ruptured anterior communicating artery aneurysm with right A1-A2 sectioning and reanastomosis

This YouTube video demonstrates the microsurgical clipping of clipping of a previously coiled and ruptured anterior communicating artery aneurysm. Initial clipping with a fenestrated clip occluded the flow in the right A2. After temporary clipping of both A1 and A2 vessels, they cut the right A1 and A2, clipped the aneurysm with a straight clip while flow was preserved in the left A1 and A2. Then an reanastomosis of the right A1-A2, end to end, was performed. This strategy allowed for complete obliteration of the aneurysm while preserving the flow in all four vessels.  

Reference:

Hage ZA, Charbel FT, “Clipping of a ruptured anterior communicating artery aneurysm with right A1-A2 sectioning and reanastomosis,” Neurosurg Focus. 2015 Jul;39 Video Suppl 1:V10

 

Clipping of bilateral MCA aneurysms and a coiled ACOM aneurysm through a modified lateral supraorbital craniotomy

This YouTube video demonstrates Dr. Charbel's microsurgical clipping of three aneurysms: a left middle cerebral artery (MCA) aneurysm performed through a modified right lateral supraorbital craniotomy, a previously coiled anterior communicating (ACOM) artery aneurysm, and a bilobed right MCA aneurysm.

The video first shows the identification and clipping of the left MCA aneurysm. Then, the ACOM aneurysm is clipped following multiple clip repositioning based on Transonic flow measurements. Finally, the right MCA aneurysm is then identified and each lobe is clipped separately. 

Reference:

Hage ZA, Charbel FT, "Clipping of bilateral MCA aneurysms and a coiled ACOM aneurysm through a modified lateral supraorbital craniotomy." Neurosurg Focus. 2015 Jan;38(VideoSuppl1):Video19.