Clipology, the Art of Aneurysm Clipping

Modern aneurysm clip is the result of almost a century of innovation from Cushing’s malleable silver clips and Mayfield’s repositionable spring-loaded clips to their current modern avatar. Dandy was the first to use a clip on an aneurysm. In 1937, he applied a V-shaped malleable silver clip to the neck of an internal carotid artery (ICA) aneurysm and obtained excellent results. Four major clip designs are currently available in the market, and these are the McFadden Vari-Angle, Sundt Slim-Line, Sugita, and Yasargil type clips. Of these, the last two are commonly available. Aneurysm clips come in various shapes such as straight, curved forward, backward, sideward, bent forward, backward, sideward, and bayoneted. Some clips can also be fenestrated, meaning they have an additional loop apart from the alpha loop to accommodate a branch if needed. The process of clipping an aneurysm requires careful planning and precise dissection. To increase motor efficiency and control any tremors, the neurosurgeon should be seated comfortably in an ergonomic position, with their elbows and hands rested.