Techniques of intracranial aneurysm wall biopsy

• Main Authors: Sajjad Muhammad, MD, PhD, Mika Niemelä, MD, PhD
• Format: Article
• Language: English
• Published: Elsevier 2019-09-01
• Series: Interdisciplinary Neurosurgery
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751919300167

Current treatment modalities for the treatment of intracranial aneurysms including surgical clipping and endovascular coiling are invasive and have some treatment risks. Since not all aneurysms rupture, it is critical to detect rupture prone aneurysms. Molecular and cellular analysis of aneurysm tissue may provide understanding about pathobiology of aneurysm rupture and to develop imaging techniques to detect rupture prone aneurysms. For more than 15-years we have collected samples to identify pathological processes in the aneurysm wall itself predisposing to rupture. This has opened a new field of research leading to novel findings and multiple scientific publications. Surgical techniques of sampling the aneurysm dome have never been demonstrated so therefore many neurosurgeons are reluctant to take biopsies for research. Now we demonstrate with an intraoperative video the techniques of sampling the aneurysm dome after clipping an incidental right-sided 5-mm unruptured MCA aneurysm in a 58-year-old hypertensive male with past long history of smoking through lateral supraorbital approach. A focused opening of the Sylvian fissure was performed and the aneurysm was clipped using standard techniques. After placement of a titanium clip, ICG and Doppler were performed to ensure patency of both M2 vessels and the aneurysm was punctured. The aneurysm dome was then held in place with the suction and cut with microscissors for research purposes. Another titanium clip was placed (Video 1). The clinical course was uneventful. This technical note will help young neurosurgeons to contribute actively in aneurysm research also potentially to find non-invasive methods to prevent aneurysms from rupture. Keywords: Intracranial aneurysm biopsy, Video demonstration, Technical aspects, Aneurysm wall research