{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:30:26Z","timestamp":1793050226623,"version":"4.5.0"},"reference-count":9,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:p>With large or giant aneurysms, the use of multiple tandem clips can be essential for complete obliteration of the aneurysm. One potential disadvantage, however, is the considerable cumulative weight of these clips, which may lead to kinking of the underlying parent vessels and obstruction of flow. The authors describe a simple technique to address this problem, guided by intraoperative blood flow measurements, in a patient with a ruptured near-giant 2.2 \u00d7 1.7\u2013cm middle cerebral artery bifurcation aneurysm that was treated with the tandem clipping technique. A total of 11 clips were applied in a vertical stacked fashion. The cumulative weight of the clips caused kinking of the temporal M<jats:sub>2<\/jats:sub> branch of the bifurcation with reduction of flow. A 4-0 Nurolon suture tie was applied to the hub of one of the clips and was tethered to the dura of the sphenoid ridge by a small mini-clip and reinforced by application of tissue sealant. The patient underwent intraoperative indocyanine green videoangiography as well as catheter angiography, which demonstrated complete aneurysmal obliteration and preservation of vessel branches. Postoperative angiography confirmed patency of the bifurcation vessels with mild vasospasm. The patient had a full recovery with no postoperative complications and was neurologically intact at her 6-month follow-up. The suture retraction technique allows a simple solution to parent vessel obstruction following aneurysm tandem clipping, in conjunction with the essential guidance provided by intraoperative flow measurements.<\/jats:p>","DOI":"10.3171\/2014.9.jns141547","type":"journal-article","created":{"date-parts":[[2015,2,27]],"date-time":"2015-02-27T14:59:13Z","timestamp":1425049153000},"page":"472-474","source":"Crossref","is-referenced-by-count":3,"title":["Suture retraction technique to prevent parent vessel obstruction following aneurysm tandem clipping"],"prefix":"10.3171","volume":"123","author":[{"given":"Tarek","family":"Rayan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepideh","family":"Amin-Hanjani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6 Suppl 3","key":"b1-jns141547","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1227\/01.NEU.0000333799.44338.19","article-title":"The utility of intraoperative blood flow measurement during aneurysm surgery using an ultrasonic perivascular flow probe","volume":"62","author":"Amin-Hanjani","year":"2008"},{"key":"b2-jns141547","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"929","DOI":"10.3171\/jns.2007.106.5.929","article-title":"Use of fenestrated aneurysm clips in microvascular decompression surgery. 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