Blading Technique for Preservation of Perforating Arteries in Clipping Surgery of Unruptured Cerebral Aneurysms

One of the most important factors for successful operation of unruptured aneurysms is preservation of perforating arteries. Various surgical approaches and methods including MEP and ICG monitoring have been reported. However, a basic safe technique of manipulating the clip blade has not been related. To preserve perforating arteries, it is important to keep the tip of the blade in the visual field until completion of clipping. I proposed the “blading technique” in order to insert the clip blade with an adequate depth and place. The ideal depth of blade might spare enough of a very thin wall at the bottom of the aneurysm to shut out flow inlet to the aneurysm and avoid damage to perforating arteries. In this technique, the operator holds an unlocked clip manipulator and clip in hand. With progression of clip blade to a deeper place, the operator manipulates the blade with 3-dimensional movements. The operator lifts up, pulls down, tilts and retracts the aneurysm minutely by the clip blade, continuously keeping the tip of the blade in sight until completion of clipping. Supportive simultaneous movement of suction device with the other hand is also very important to secure the visual field.