Late postoperative slippage of the cerebral aneurysm clip. A systematic review and meta-analysis

<p><strong>Background</strong>: A late clip slippage from the previously properly secured cerebral aneurysm is rarely observed. To date these complicatons have not pooled and evaluated using systematc review methodology. The objectve was to report factors atributed to the late slippage of the aneurysm clip in the postoperatve period. <strong>Materials and methods</strong>: All causes of postoperatve clip slippage were systematcally reviewed and analysed according to PRISMA Individual Patent Data protocol. Medline (PubMed), Embase, Cochrane, ISI Web of Knowledge and Google Scholar were searched for all relevant cases. <strong>Results</strong>: Systematc review of the literature yielded 105 original cases proving slipped clip in the postoperatve period. The slipped clip caused bleeding in 53.8% of patents. The putatve cause of clip slippage was provided in only 34.7% of the published cases. If a single clip was used, then complete clip slippage was noted more ofen (p&#61;0.04). Multple clipping and clip-wrapping techniques were postulated as ways to prevent postoperatve clip slippage. <strong>Conclusions</strong>: The reason for late slippage of the aneurysm clip remains unexplained by most authors. Based on systematc reviewing, the use of tandem of clips prevents their late migraton of the aneurysm. Clipping with wrapping or use of a single clip reinforced by any wrapping material seems a more durable soluton.<br /></p>