Clipping on sling-wrap method using a polyglycolic acid sheet in a thin-walled or atherosclerotic middle cerebral artery aneurysm: technique note.

During surgical treatment of cerebral aneurysm, thin-walled or severe atherosclerotic aneurysms on the middle cerebral artery are sometimes observed. Owing to the vulnerability or stiffness of the aneurysm, simple neck clipping is usually difficult. We aimed to describe a sling-wrap clipping method using a polyglycolic acid (PGA) sheet for thin-walled or atherosclerotic middle cerebral artery aneurysms. The sling-wrap clipping method was performed in six patients with middle cerebral artery aneurysms. After the distal Sylvian approach, the aneurysm and parent artery were slung up like a baby sling by using a transparent PGA sheet. The aneurysm was directly clipped with the PGA sheet by grasping both ends of the sheet and holding them up. Contrary to the existing wrapping methods, our method could directly obstruct the aneurysm under good visibility through the sheet, thereby avoiding slipping in/out of the clip blade. All cases of the sling-wrap clipping method performed in this study were successful. No problems related to this method were encountered. Aneurysm recurrence, allergic reaction to the PGA sheet, and parent artery stenosis were not observed during the follow-up period. The sling-wrap clipping method using a PGA sheet is safe and another surgical option for thin-walled or atherosclerotic middle cerebral artery aneurysms.