Management

**147**

clipping

**1. Introduction**

**Chapter 10**

**Abstract**

Aneurysms

further enhance postoperative results.

Preventing Rupture: Clipping

of Unruptured Intracranial

*Ioan Alexandru Florian, Teodora Larisa Timis,* 

*Cristina Caterina Aldea and Ioan Stefan Florian*

Unruptured intracranial aneurysms (UIAs) represent a major public health issue due to their unpredictable natural history. Whether to actively treat them or to maintain them under observation remains a hotly disputed topic. In this chapter, we present a review of the literature regarding the history of clipping and its use in UIAs, as well as the experience of our senior author in this field. We performed an extensive Medline and Google Academic search of the relevant literature. We have also made a retrospective analysis on patients harboring UIAs and multiple intracranial aneurysms (MIAs) clipped by the senior author between 1997 and 2017. About 89 patients had solitary UIAs, alongside 101 with MIAs possessing 257 individual aneurysms in total. All UIA patients were discharged with a favorable neurological outcome and no mortality. Concerning MIAs, the majority of cases had 2 aneurysms, the highest number being 6. And, 61 patients from this group had a favorable outcome. In the hands of experienced vascular neurosurgeons, clipping remains a safe option for both UIAs and MIAs. This procedure offers a long-lasting protection from aneurysmal rupture. In the future, new clip technologies and intraprocedural methods of verifying vessel patency and aneurysmal occlusion may

**Keywords:** intracranial aneurysm, multiple aneurysms, unruptured, surgery,

Once considered as the definitive curative option for intracranial aneurysms (IAs), clipping has steadily lost its footing in the face of the less invasive and lowerrisk-laden endovascular procedures. Successful clipping implies completely occluding the aneurysmal sack at its origin on the parent artery, significantly diminishing the risk of rupture and ensuing morbidity. The procedure is especially indicated for ruptured aneurysms. However, there is ongoing debate regarding the necessity for surgery in the case of unruptured intracranial aneurysms (UIAs). Since many of these patients also harbor more than one aneurysm, another controversial aspect in neurosurgery is whether to treat all aneurysms in the same session or to leave the unruptured lesions for a delayed intervention or even for an endovascular
