gms | German Medical Science

Objective: Besides the ongoing debate on whether surgical clipping or endovascular coiling comes along with the most favorable outcome in patients with intracranial aneurysms, surgical treatment still counts to daily routine. A lot of effort has been made to reduce surgical invasiveness while achieving optimal usage of the surgical field. In this context, the Lazic L-Clip System® has already proven its benefits. This study introduces the new generation of Lazic D-Clips® in aneurysm surgery for the first time.

Methods: The department’s internal database was searched for surgical clipping procedures using Lazic D-Clips® between 2015 and 2018. Medical data sets, including pre- and postoperative clinical status, as well as detailed perioperative imaging were assessed out of a prospectively maintained data pool. Immediately after the operation, the main surgeon, as well as the nursing staff involved, documented handling and feasibility aspects by a standardized questionnaire for every single D-Clip® applied. Intraoperative video documentation was reviewed by an objective neurosurgeon respectively.

Results: 45 patients with a total of 49 intracranial aneurysms could be included into final analysis. Two patients presented with acute SAH. A total of 63 Lazic D-Clips® have been applied. Average aneurysm size was 5.5x5.5x4.8mm. Temporary clipping of proximal arteries was necessary in 18 procedures. All aneurysms could be occluded totally. The surgeon’s review revealed a good handling in all cases (100%), even if visibility was impaired in 11.11%. Clip replacement was necessary in nine applications (12.7%). Handling of the clip replacement was considered good in all cases (100%). Video analysis showed nearly identic results: Handling was considered as good in 62 applications (98.41%) even if visibility was considered as impaired in 12 applications (19.05%). Clip replacements and handling of temporary clips was considered as good in all cases (100%). There were no intraoperative complications, such as rupture of the aneurysm or severe bleeding due to other causes.

Conclusion: The new Lazic D-Clip System® combines an attenuated design for minimally invasive clipping procedures with the traditional character of aneurysm clip systems. It is therefore highly versatile in context of variable different aneurysm morphologies and locations while maintaining high standard surgical safety and effectiveness for the individual patient.