Double-clip technique for the microneurosurgical management of very small (< 3 mm) intracranial aneurysms.

BACKGROUND: The treatment of very small (≤ 3 mm) aneurysms is technically challenging. Mini-clips used for clipping these small aneurysms have a smaller closing force compared with standard clips. OBJECTIVE: To describe the double-clip technique for very small aneurysms. METHODS: The double-clip technique, a parallel duplication clipping technique of booster clipping, is used by the senior author for clipping very small aneurysms with morphology suitable for the application of 2 clips. The aneurysm is clipped after application of temporary clip(s), administration of adenosine, or both. An initial mini-clip is applied, leaving a small residual neck sufficient for application of the second mini-clip. A second mini-clip of the same size and shape is applied on the residual neck parallel to the initial clip. The initially applied mini-clip, which is in close contact with the second clip, supports the second clip and prevents its slippage. This technique was retrospectively reviewed over a 13-year period (1997-2009). There were 3246 patients with 4757 aneurysms treated in the same period. RESULTS: The outcomes of 39 patients with 40 very small aneurysms clipped with the double-clip technique were analyzed. None of the patients had technique-related complications. Postoperative angiograms revealed complete aneurysm occlusion of 39 aneurysms and a small residual neck in 1 aneurysm. No parent artery obstruction was observed in the postoperative angiogram. CONCLUSION: The double-clip technique is a safe and effective variation of booster clipping in the treatment of very small aneurysms with suitable morphology.

A multivariate analysis of patients with glioma: a treatment outcome and prognostic factor for survival.

OBJECTIVE: To evaluate the treatment outcome and to examine the influence of factors on survival of patients with glioma. MATERIAL AND METHOD: One hundred and eighty-nine patients were included. Data on the patient's age, sex, KPS score, tumor location and survival time were collected and analyzed. RESULTS: Tumor grade and age had effect on survival of the patients. The median survival time (MST) of patients with grade II-IV glioma was 80.0, 20.0 and 9 months, respectively. Only the tumor site had influence on survival of patients with grade II glioma. In patients with grade III glioma, only KPS score had an impact on survival. In patients with grade IV glioma, none of the factors had an effect on survival. CONCLUSION: The treatment outcome of the patients in Chulalongkorn University is comparable to other series. Multivariate analysis identified factors that had influence on survival of the patients.