The Impact of Temporary Artery Occlusion During Intracranial Aneurysm Surgery on Long-Term Clinical Outcome: Part I. Patients with Subarachnoid Hemorrhage

Griessenauer, Christoph J.; Poston, Tyler; Shoja, Mohammadali Mohajel; Mortazavi, Martin M.; Falola, Michael; Tubbs, R. Shane; Fisher, Winfield S.

doi:10.1016/j.wneu.2013.02.068

Cited by 29 publications

(27 citation statements)

References 26 publications

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“…Temporary clipping with a mean duration of 19 minutes had no negative influence on clinical outcome. 11,12 It is well known that vasospasm and DCI are the main contributors to poor outcome in aSAH patients. Despite not being investigated in these 2 studies, the lack of effect of temporary clipping on outcome can be seen as a surrogate parameter for a lack of effect of temporary clipping on the incidence of vasospasm and DCI.…”

Section: Does Microsurgery Contribute To Vasospasm?mentioning

confidence: 99%

The impact of temporary clipping during aneurysm surgery on the incidence of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Malinova

Schatlo

Voit

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Clipping of a ruptured intracranial aneurysm requires some degree of vessel manipulation, which in turn is believed to contribute to vasoconstriction. One of the techniques used during surgery is temporary clipping of the parent vessel. Temporary clipping may either be mandatory in cases of premature rupture (rescue) or represent a precautionary or facilitating surgical step (elective). The aim of this study was to study the association between temporary clipping during aneurysm surgery and the incidence of vasospasm and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (aSAH) in a large clinical series. METHODS Seven hundred seventy-eight patients who underwent surgical aneurysm treatment after aSAH were retrospectively included in the study. In addition to surgical parameters, the authors recorded transcranial Doppler (TCD) sonography-documented vasospasm (TCD-vasospasm, blood flow acceleration > 120 cm/sec), delayed ischemic neurological deficits (DINDs), and delayed cerebral infarction (DCI). Multivariate binary logistic regression analysis was applied to assess the association between temporary clipping, vasospasm, DIND, and DCI. RESULTS Temporary clipping was performed in 338 (43.4%) of 778 patients during aneurysm surgery. TCD sonographic flow acceleration developed in 370 (47.6%), DINDs in 123 (15.8%), and DCI in 97 (12.5%). Patients with temporary clipping showed no significant increase in the incidence of TCD-vasospasm compared with patients without temporary clipping (49% vs 48%, respectively; p = 0.60). DINDs developed in 12% of patients with temporary clipping and 18% of those without temporary clipping (p = 0.01). DCI occurred in 9% of patients with temporary clipping and 15% of those without temporary clipping (p = 0.02). The need for rescue temporary clipping was a predictor for DCI; 19.5% of patients in the rescue temporary clipping group but only 11.3% in the elective temporary clipping group had infarcts (p = 0.02). Elective temporary clipping was not associated with TCD-vasospasm (p = 0.31), DIND (p = 0.18), or DCI (p = 0.06). CONCLUSIONS Temporary clipping did not contribute to a higher rate of TCD-vasospasm, DIND, or DCI in comparison with rates in patients without temporary clipping. In contrast, there was an association between temporary clipping and a lower incidence of DINDs and DCI. There is no reason to be hesitant in using elective temporary clipping if deemed appropriate.

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Section: Does Microsurgery Contribute To Vasospasm?mentioning

confidence: 99%

The impact of temporary clipping during aneurysm surgery on the incidence of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Malinova

Schatlo

Voit

et al. 2018

Journal of Neurosurgery

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“…Care should be taken, however, to avoid prolonged occlusion times during this anastomosis as small PICA perforating vessels (< 1 mm) may be at risk. However, a longer clamping time has not been shown to have negative impact on clinical outcome in larger studies [22].…”

Section: Discussionmentioning

confidence: 93%

Multiple aneurysms on inter-PICA communicating collaterals: case report on a rare entity

Mortazavi¹,

Frerich²,

Sekhar³

2014

Cureus

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Aneurysms arising from the posterior inferior cerebellar artery (PICA) to PICA communicating collaterals are very rare. Only five cases have so far been described in the literature. Here, we report the first case with multiple aneurysms occurring on separate inter-PICA communicating collateral arteries, where one of the PICA's was occluded proximally and reconstituted distally through the inter-PICA collateral arteries, in a patient presenting with subarachnoid hemorrhage. After standard management, the ruptured aneurysm was resected, and the other unruptured aneurysm was clipped. Side-to-side PICA-to-PICA anastomosis distal to the communicating collaterals was performed in order to maintain collateral circulation to the brainstem. Clinicians should be aware of the possibility of these rare aneurysms, and should consider in situ bypass in the management of PICA aneurysms where the aneurysm is proximal to the telovelotonsillary segment of PICA. Categories: Neurosurgery

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“…Temporary parent vessel occlusion seems to be a safe procedure. Interestingly, a study with a mean follow-up of 53 months showed that a temporary artery occlusion time (mean 16.1 min) had no effect on overall long-term clinical outcomes [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms

et al. 2020

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Based on the relationship between the posterior clinoid process and the basilar artery (BA) apex it may be difficult to obtain proximal control of the BA using temporary clips. Endovascular BA temporary balloon occlusion (TBO) can reduce aneurysm sac pressure, facilitate dissection/clipping, and finally lower the risk of intraoperative rupture. We present our experience with TBO during aneurysm clipping of posterior circulation aneurysms within the setting of a hybrid operating room (hOR). We report one case each of a basilar tip, posterior cerebral artery, and superior cerebellar artery aneurysm that underwent surgical occlusion under TBO within an hOR. Surgical exposure of the BA was achieved with a pterional approach and selective anterior and posterior clinoidectomy. Intraoperative digital subtraction angiography (iDSA) was performed prior, during, and after aneurysm occlusion. Two patients presented with subarachnoid hemorrhage and one patient presented with an unruptured aneurysm. The intraluminal balloon was inserted through the femoral artery and inflated in the BA after craniotomy to allow further dissection of the parent vessel and branches needed for the preparation of the aneurysm neck. No complications during balloon inflation and aneurysm dissection occurred. Intraoperative aneurysm rupture prior to clipping did not occur. The duration of TBO varied between 9 and 11 min. Small neck aneurysm remnants were present in two cases (BA and PCA). Two patients recovered well with a GOS 5 after surgery and one patient died due to complications unrelated to surgery. Intraoperative TBO within the hOR is a feasible and safe procedure with no additional morbidity when using a standardized protocol and setting. No relevant side effects or intraoperative complications were present in this series. In addition, iDSA in an hOR facilitates the evaluation of the surgical result and 3D reconstructions provide documentation of potential aneurysm remnants for future follow-up.

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The Impact of Temporary Artery Occlusion During Intracranial Aneurysm Surgery on Long-Term Clinical Outcome: Part I. Patients with Subarachnoid Hemorrhage

Cited by 29 publications

References 26 publications

The impact of temporary clipping during aneurysm surgery on the incidence of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

The impact of temporary clipping during aneurysm surgery on the incidence of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Multiple aneurysms on inter-PICA communicating collaterals: case report on a rare entity

Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms

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