Application of a New Fenestrated Clip (Yaşargil T-Bar Clip) for the Treatment of Fusiform M1 Aneurysm

Abstract

Fusiform intracranial aneurysms (FIAs) are challenging to treat by surgical and endovascular means because of their complex morphology and configurations. Various surgical techniques, including clip reconstruction, wrapping with or without clip enforcement, and trapping with or without bypass, have been described extensively. The objective of this study is to describe the application of a new fenestrated clip (Yaşargil T-bar clip) for the treatment of FIAs. An FIA on the M1 segment of the middle cerebral artery was diagnosed incidentally in a 23-year-old man. The aneurysm was visualized after wide dissection of the sylvian fissure. The M1 segment of the middle cerebral artery, its branches, and its lenticulostriate arteries were identified and dissected. A single fenestrated T-bar clip was applied to reconstruct this long FIA after one of the lenticulostriate arteries was dissected free of the aneurysm. Postoperative angiography confirmed reconstruction of the M1 segment and obliteration of the aneurysm. Clip reconstruction of an FIA with a fenestrated Yaşargil T-bar clip is a new application option that effectively reconstructs the parent artery. Application of this type of a clip might be advantageous over conventional fenestrated or nonfenestrated clip applications, especially in tight surgical fields, because a single clip might be sufficient to reconstruct the long segment of the artery.