Temporary clipping during intracranial aneurysm surgery: Continuous (CTC) versus intermittent (ITC), the effect on outcome.

The intra-operative rupture of intracranial aneurysms (IA) occurs in 5–30% of cases as reported in the literature. This event is frequently associated with an increase in mortality and morbidity. The aim of this study was to evaluate the prognostic importance of temporary clipping in intracranial aneurysm surgery. A series of 304 cases of IA treated surgically were selected by excluding giant or Hunt-Hess grade >3 aneurysms. Two groups of patients were compared: one of 157 cases that had temporary clipping (TC) during surgery and the other of 147 patients who did not have TC. The neuroprotective measures used were the infusion of Thiopental and maintenance of adequate blood pressure by use of Bitartrate Metaraminol and Ephedrine. The surgical complications, chiefly intra-operative rupture of the sac and consequences of malpositioning the clip with associated clinical complications, were considered. The two groups were compared using χ2 that showed a statistically significant reduction of the surgical complications in those patients who had TC. The associated poor clinical outcome was reduced from 7.5% to 2.5%. The main prognostic factor in determining the ischemic damage was the occlusion time of the local arterial circulation. The mean occlusion time in these patients was limited to four minutes and in only 12 cases reached 15–16 minutes without ischemic complications. Temporary clipping reduces the risk of intra-operative rupture of aneurysm and permits a better dissection of the sac with an adequate positioning of the definitive clip. In cases of small aneurysm with an easily accessible neck (that predict a temporary occlusion of the local arterial circulation) we consider the maintenance of optimal blood pressure very important. However we do not consider it essential to use electrophysiologic monitoring or other particular techniques of neuroprotection (which are vital in the surgery of giant or complex aneurysms).

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Does Temporary Clipping during Intracranial Aneurysm Surgery Influence Cognitive Outcome?

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0035-1566397 ◽

2015 ◽

Vol 76 (S 02) ◽

Author(s):

V. Papic ◽

T. Cigic ◽

V. Bugarski ◽

D. Djilvesi ◽

M. Karan ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Cognitive Outcome ◽

Aneurysm Surgery ◽

Temporary Clipping

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Effect of intraoperative brain protection with propofol on postoperative cognition in patients undergoing temporary clipping during intracranial aneurysm surgery

Neurology India ◽

10.4103/0028-3886.136908 ◽

2014 ◽

Vol 62 (3) ◽

pp. 262 ◽

Cited By ~ 8

Author(s):

GirijaPrasad Rath ◽

HariHara Dash ◽

Ashish Suri ◽

PSarat Chandra ◽

Aman Mahajan ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Aneurysm Surgery ◽

Brain Protection ◽

Temporary Clipping

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Adenosine-induced cardiac arrest as an alternative to temporary clipping during intracranial aneurysm surgery

Journal of Neurosurgery ◽

10.3171/2017.5.jns162469 ◽

2018 ◽

Vol 129 (3) ◽

pp. 684-690 ◽

Cited By ~ 7

Author(s):

Patcharin Intarakhao ◽

Peeraphong Thiarawat ◽

Behnam Rezai Jahromi ◽

Danil A. Kozyrev ◽

Mario K. Teo ◽

...

Keyword(s):

Cardiac Arrest ◽

Intracranial Aneurysm ◽

Secondary Outcome ◽

Aneurysm Surgery ◽

Group A ◽

Group B ◽

Matching Criteria ◽

The Impact ◽

Temporary Clipping ◽

Induced Cardiac Arrest

OBJECTIVEThe purpose of this study was to analyze the impact of adenosine-induced cardiac arrest (AiCA) on temporary clipping (TC) and the postoperative cerebral infarction rate among patients undergoing intracranial aneurysm surgery.METHODSIn this retrospective matched-cohort study, 65 patients who received adenosine for decompression of aneurysms during microsurgical clipping were identified (Group A) and randomly matched with 65 selected patients who underwent clipping but did not receive adenosine during surgery (Group B). The matching criteria included age, Fisher grade, aneurysm size, rupture status, and location of aneurysms. The primary outcomes were TC time and the postoperative infarction rate. The secondary outcome was the incidence of intraoperative aneurysm rupture (IAR).RESULTSIn Group A, 40 patients underwent clipping with AiCA alone and 25 patients (38%) received AiCA combined with TC, and in Group B, 60 patients (92%) underwent aneurysm clipping under the protection of TC (OR 0.052; 95% CI 0.018–0.147; p < 0.001). Group A required less TC time (2.04 minutes vs 4.46 minutes; p < 0.001). The incidence of postoperative lacunar infarction was equal in both groups (6.2%). There was an insignificant between-group difference in the incidence of IAR (1.5% in Group A vs 6.1% in Group B; OR 0.238; 95% CI 0.026–2.192; p = 0.171).CONCLUSIONSAiCA is a useful technique for microneurosurgical treatment of cerebral aneurysms. AiCA can minimize the use of TC and does not increase the risk of IAR and postoperative infarction.

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