Am J Otolaryngol Head Neck Surg | Volume 6, Issue 6 | Research Article | Open Access

Surgical Treatment of Very Small Aneurysms: Cotton-Assisted Clipping

Huang Y1, Gao G2#, Zhang S1*, Liu J1#, Wu J1, Hu X1, Lu J2, Zhang Q2, Zhou L1 and Huang Y1*

1Department of Neurosurgery, The First Affiliated Hospital of Soochow University, China
2Department of Neurosurgery, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
#These authors contributed equally to this work

*Correspondance to: Shiming Zhang,Yulun Huang 

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Objective: Very small Intracranial Aneurysms (VSIAs) are challenging to treat because aneurysm tearing and clip slippage can occur during neurosurgical clipping. In this study, we introduce and share our experience with cotton-assisted clipping of VSIAs. Materials and Methods: We retrospectively analyzed the data of 20 patients with 24 VSIAs treated with cotton-assisted clipping between February 2008 and December 2014 in the Neurosurgery Departments of the First Aliated Hospital, Soochow University and Taizhou People's Hospital. During surgery, 2 aneurysm necks were torn. To treat the tears, we wrapped rectangular cotton pads around the parental arteries at the site of rupture. e remaining 22 aneurysms were clipped aer being wrapped in cotton pads. Results: e 2 aneurysm ruptures were successfully repaired with cotton-assisted clipping. In the remaining 22 aneurysms, no cases of aneurysm clip slippage or aneurysm rupture occurred. Patients were followed up on average for 59.0 months (range, 30-113 months). Of the 20 patients, the 16 patients with preoperative Hunt-Hess grades of 1 to 3 recovered well aer the surgery (Glasgow Outcome Scale [GOS] score, 5). Of the 4 patients with Hunt-Hess grades of 4 to 5.3 had a good recovery (GOS scores, 4-5), and 1 patient died of heart disease 6 months aer being discharged from the hospital; this patient had a GOS score of 4 at the time of discharge. Conclusion: Cotton-assisted clipping could prevent aneurysm clip slipping and aneurysm rupture and facilitate the repair of aneurysm neck tears. is technique is a useful alternative therapy for VSIAs.


Clipping; Cotton pads; Treatment outcome; Very small aneurysm


Huang Y, Gao G, Zhang S, Liu J, Wu J, Hu X, et al. Surgical Treatment of Very Small Aneurysms: Cotton-Assisted Clipping. Am J Otolaryngol Head Neck Surg. 2023;6(6):1247..

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