Basics of Aneurysmal Clipping Surgery : The Importance of Wide Operative Field and Repeated Training

Abstract

To improve the safety of aneurysmal clipping as well as to develop neurosurgical skills of residents simultaneously, we present the technical details and setting adopted in our institution. Between 2006 and 2011, we experienced 379 aneurysmal clipping surgeries (209 ruptured, 170 unruptured) at Fuji Brain Institute and Hospital. With daily thorough in-vitro microsurgical training, we performed standard-sized craniotomies with open fissures such as the sylvian fissure or interhemispheric fissure, to obtain a safe wide surgical field for clipping to compensate for the lack of experience in young neurosurgeons. We made every effort to be meticulous rather than fast to maintain treatment safety. To enhance the understanding for the surgical setting, method and strategy, we standardized procedures in detail to maximize the practice effect for residents with a limited amount of surgical experience. We discuss our institutional experiences in developing the surgical skills of young neurosurgeons, with the aim of having residents perform real neurosurgical micro-operations under the supervision of a staff doctor without compromising safety.