• Yosuke Akamatsu, Hiroshi Kashimura, Taro Suzuki, Kenta Aso, and Sotaro Oshida.
• Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
• World Neurosurg. 2019 Feb 1; 122: 240-244.

BackgroundFenestrated miniclips were developed as an effective tool for dog-ear-shaped remnants of aneurysms. However, the special property of these clips may have other applications. Here, we report 2 cases of ruptured small aneurysm and suggest the alternative utility of a single application of a fenestrated miniclip.Case DescriptionA 77-year-old woman was admitted to our hospital with subarachnoid hemorrhage due to an anterior communicating aneurysm. The aneurysm was treated with surgical clipping via a right pterional approach. Because dissection of tight adhesion between the aneurysm and ipsilateral A2 might cause intraoperative bleeding, the angled fenestrated miniclip was applied across the ipsilateral A2 without dissection of adhesion and obliterated the aneurysm without complications. In another case, a 60-year-old man presented with subarachnoid hemorrhage due to ruptured vertebral artery-posterior inferior cerebellar artery (PICA) aneurysm and was treated with surgical clipping via a far-lateral approach. Because aneurysm visualization was impeded by PICA even after mobilization of the PICA and vertebral artery, a fenestrated standard-clip was applied across the PICA. However, this clip impeded visualization of the aneurysm and could not be opened in the tight surgical field. In contrast, subsequent application of a fenestrated miniclip allowed better visualization of the aneurysm, even in a tight field, and resulted in successful obliteration of the aneurysm.ConclusionSingle application of fenestrated mini-clips may be suitable in cases of small aneurysms with thin walls adhering to branch vessels or where visualization of the aneurysm is impeded by the parent artery.Copyright © 2018 Elsevier Inc. All rights reserved.

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