#hiphopneurosurgery

[neurocirurgiabr]

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A post shared by Julio Pereira Neurocirurgiabr (@neurocirurgiabr)

This small unruptured right middle cerebral artery (MCA) #Repost @skullbasemd aneurysm had blister-like thin walls, incorporating the backside of the MCA bifurcation. Initial attempts at more simple clip configurations left a residual on the backside of the bifurcation due to the bulbous nature of the neck. So I revised it to a picket fence configuration. This is done by lining up the clips much like a picket fence to reconstruct the lumen of the parent artery while carefully preserving flow through the the M2 vessels. In neurosurgery, sometimes you have to be creative come up with a “Plan B” solution and “MacGyver” it to fix the problem. . Technical pearls: I put a temporary clip on M1 segment to decrease the turgor to the aneurysm. The clip is already on in case there is an inteaopertive aneurysm rupture during clip application. The first clip used is a fenestrated clip to close off that backside of the neck. The next two clips are stacked parallel to the first clip to sequentially close off the aneurysm with care to preserve flow through the M2 vessels. The last clip is a 3 mm mini clip to occlude a small remnant that was still allowing flow into the aneurysm dome. Intraop fluorescein and ICG angiography showed occlusion of the aneurysm and flow through the M1 and M2 vessels. . #motivationmonday #aneurysm #skullbasesurgery #hiphopneurosurgery #mashup #drizzy #preservingthecraft #makingadifference #rutgersneurosurgery #doctor #surgeon #medicine #medstudent #nurse @bafound @rutgersneurosurgery @rutgersnjms @Rutgers @rwjbarnabas_health @university_hospital_newark #neurosurgeryblog #neurocirurgiabr https://www.instagram.com/p/BoL4No4lMC7/?utm_source=ig_tumblr_share&igshid=115w34euohafr