Review of temporary arterial clipping in intracranial aneurysm surgery: Historical insights, current techniques, and future directions

Temporary arterial clipping has proven transformative in enhancing surgical precision and safety, reducing intraoperative aneurysm rupture, and improving recovery rates. It aids aneurysm sac dissection while potentially minimizing vasospasm risk. Controversies remain regarding the safe duration of temporary arterial clipping and its effects on vasospasm, as well as concerns over stent deformation during clipping in stent-assisted procedures. Emerging evidence suggests that tailoring temporary arterial clipping protocols—such as single prolonged versus multiple shorter periods—based on aneurysm type and patient factors may optimize outcomes. This review systematically investigated the clinical use of temporary arterial clipping in intracranial aneurysm surgery by searching major biomedical databases (PubMed, Medline, Scopus, Cochrane, Embase, and Google Scholar) with terms like “Temporary clipping,” “Cerebral aneurysm,” and “Aneurysm.” It examines the role of temporary arterial clipping, highlighting its clinical impact, benefits, controversies, and future directions. The historical evolution of temporary arterial clipping from early pioneers to modern applications is traced, focusing on its utility in aneurysm dissection, intraoperative rupture prevention, and improved neurological outcomes. Key considerations include the relationship between temporary arterial clipping duration and vasospasm, neuroprotective strategies, and its use in stent-assisted aneurysms. Future advancements should focus on developing innovative clipping devices, enhanced intraoperative monitoring, and effective neuroprotective measures. Rigorous clinical trials are needed to refine temporary arterial clipping protocols and improve patient outcomes, reinforcing its critical role in modern intracranial aneurysm surgery. In conclusion, temporary arterial clipping remains an indispensable technique, fundamentally enhancing surgical safety and precision in intracranial aneurysm management. While its transformative impact is evident, persistent controversies surrounding optimal duration, neuroprotection, and use in stent-assisted cases underscore an urgent need for rigorous, standardized multicenter trials. These future investigations are crucial to refine temporary arterial clipping protocols, harness technological advancements, and ultimately optimize patient outcomes, solidifying temporary arterial clipping’s critical and evolving role in contemporary neurosurgical practice.