Does the impact of elective temporary clipping on intraoperative rupture really influence neurological outcome after surgery for ruptured anterior circulation aneurysms?—A prospective multivariate study
- 8 December 2012
- journal article
- Published by Springer Science and Business Media LLC in Acta Neurochirurgica
- Vol. 155 (2), 237-246
- https://doi.org/10.1007/s00701-012-1571-2
Abstract
Elective temporary clipping (ETC) is increasingly used in surgery for aneurysms. This study was to assess whether the impact of ETC on intraoperative aneurysmal rupture (IAR) translates into neurological outcome. Patients who underwent surgery for ruptured anterior circulation aneurysms were prospectively studied for various factors related to ETC, IAR and neurological outcome at 3 months. Univariate and multivariate analyses were performed using SPSS20. Of the total 273 ruptured aneurysm surgeries studied, IAR was observed in only six out of 132 aneurysms (4.5 %) who had ETC, compared with 78 out of 141 (55.3 %) without ETC (p < 0.001). Aneurysms complicated by IAR had significantly longer clipping time (8.3 min) compared with those without IAR (1.9 min) (p < 0.001). IAR had significant association with unfavorable outcome (38 % vs. 24 %) (p = 0.02). Patients with ETC had significantly shorter clipping time (2.9 min) compared with those without ETC (4.8 min) (p = 0.02). Unfavorable outcome was noted in 30 out of 132 with ETC (23 %), compared with 48 out of 141 without ETC (34 %) (p = 0.04). This beneficial effect was nonsignificantly greater in younger and good clinical grade patients. While episodes of ETC within clipping time of 20 min did not show significant difference in outcome, repeated rescue clipping (45 % unfavorable outcome, p = 0.048) and total clipping time of at least 20 min (75 % unfavorable outcome, p = 0.008) had significant impact on outcome. In multivariate analysis, the use of ETC (p = 0.027) and total temporary clipping less than 20 min (p = 0.049) were noted to result in significantly better outcome, independent of other factors. The use of ETC decreased the occurrence of IAR and the total clipping time, thereby leading to significantly better outcome, independent of other factors. While repeated elective clipping within total clipping time of 20 min did not influence outcome, repeated rescue clipping and total clipping time of at least 20 min had significant impact on outcome.Keywords
This publication has 26 references indexed in Scilit:
- Temporary arterial occlusion in the repair of ruptured intracranial aneurysms: an analysis of risk factors for strokeJournal of Neurosurgery, 2002
- The Incidence of Surgical Complications Is Similar in Good and Poor Grade Patients Undergoing Repair of Ruptured Anterior Circulation Aneurysms: A Retrospective Review of 355 PatientsNeurosurgery, 1996
- Outcome and management of intraoperative aneurysm ruptureSurgical Neurology, 1993
- Limitation of temporary vascular occlusion during aneurysm surgery: Study by intraoperative monitoring of cortical blood flowSurgical Neurology, 1991
- Temporary clipping in aneurysm surgery: Technique and resultsSurgical Neurology, 1991
- A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies.Journal of Neurology, Neurosurgery & Psychiatry, 1988
- Results and complications of surgical management of 809 intracranial aneurysms in 722 casesJournal of Neurosurgery, 1982
- Relation of Cerebral Vasospasm to Subarachnoid Hemorrhage Visualized by Computerized Tomographic ScanningNeurosurgery, 1980
- The Safe Time Limit of Temporary Clamping of Cerebral Arteries in the Direct Surgical Treatment of Intracranial Aneurysm under Moderate HypothermiaThe Tohoku Journal of Experimental Medicine, 1979
- ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical ScaleThe Lancet, 1975