Use of dome coagulation technique in clipping of intracranial aneurysms. Operating microscope has made clipping of intracranial aneurysms safe and accurate. When bigger than large sized aneurysms are encountered, it is sometimes difficult to see the opposite side of the aneurysm, even after clipping the neck of the aneurysm.
Clipping was sometimes found to be incomplete on inspection after the aneurysm dome was coagulated to a smaller size. Coagulated artery shows degenerative changes histologically. Degenerative tissue is thought to be weak and is predisposed to the development of new aneurysm and subsequent rupture. Hence aneurysm neck plasty seems to be dangerous. So, after clipping, I coagulate the aneurysm dome to make it small.
When the aneurysm is clipped completely, instead of directly coagulating, the dome is ruptured, and then coagulated to a smaller size. When the aneurysm is not clipped completely, the dome is coagulated to a smaller size. Then the placement of the clip is easily verified. When it is found incomplete or include a smaller branch, proper correction is made after the shrinking the aneurysm to a confortable size.