Ambidextrous Clipping of Aneurysms, its Efficacies and Indications

Kim, Tae Hyung; Sung, Jae Hoon; Kim, Il Sup; Yang, Seung Ho; Hong, Jae Taek; Son, Byung Chul; Lee, Sang Won

Abstract

OBJECTIVE
The purpose of this study is to evaluate the efficacy and indications of ambidextrous handling in aneurysm clipping surgery.
METHODS
Thirty-seven patients with cases of surgically clipped aneurysms of anterior circulation were enrolled into the study. The site, direction, and neck size of the aneurysms were verified by angiography. The handedness that was use to apply the clip during surgical intervention was reviewed by viewing videotapes of the operations and patient medical records. We analyzed the relationship between characteristics of aneurysms and handedness (left or right hand) used. RESULTS: The left hand was used to perform the clipping in 14 cases (37.8%). Of those cases, trial of the left hand resulted in safer, parallel and complete clippings. The left hand was effective for clipping of left internal carotid artery aneurysms with ventral projection and proximal anterior cerebral artery aneurysm. Middle cerebral artery aneurysms were clipped by left hand more frequently (44.4%). In cases of anterior communicating artery and posterior communicating artery aneurysms, the laterality did not influence hand choice. The left hand was useful for parallel clipping in narrow space (64.3%) or by clip readjustment for remnant sac control (35.7%). CONCLUSION: For parallel clipping and remnant sac control of aneurysms, familiarity with ambidextrous handling of the clip applier is very effective and helpful.