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

详细信息    查看全文

• 作者：Sivashanmugam Dhandapani (1)
  Sudhir S. Pal (1)
  Sunil K. Gupta (1) (3)
  Sandeep Mohindra (1)
  Rajesh Chhabra (1)
  Surender K. Malhotra (2)
  
• 关键词：Elective temporary clipping ; intraoperative aneurysmal rupture ; Neurological outcome
• 刊名：Acta Neurochirurgica
• 出版年：2013
• 出版时间：February 2013
• 年：2013
• 卷：155
• 期：2
• 页码：237-246
• 全文大小：429KB
• 参考文献：1. Batjer H, Samson D (1986) Intraoperative aneurysmal rupture: incidence, outcome, and suggestions for surgical management. Neurosurgery 18:701-06 CrossRef
  2. Giannotta SL, Oppenheimer JH, Levy ML, Zelman V (1991) Management of intraoperative rupture of aneurysm without hypotension. Neurosurgery 28:531-36 CrossRef
  3. Le Roux PD, Elliott JP, Downey L, Newell DW, Grady MS, Mayberg MR, Eskridge JM, Winn HR (1995) Improved outcome after rupture of anterior circulation aneurysms: a retrospective 10-year review of 224 good-grade patients. J Neurosurg 83:394-02 CrossRef
  4. Le Roux PD, Elliott JP, Newell DW, Grady MS, Winn HR (1996) 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 patients. Neurosurgery 38:887-95 CrossRef
  5. Leipzig TJ, Morgan J, Horner TG, Payner T, Redelman K, Johnson CS (2005) Analysis of intraoperative rupture in the surgical treatment of 1,694 saccular aneurysms. Neurosurgery 56:455-68 CrossRef
  6. Schramm J, Cedzich C (1993) Outcome and management of intraoperative aneurysm rupture. Surg Neurol 40:26-0 CrossRef
  7. Sundt TM, Kobayashi S, Fode NC, Whisnant JP (1982) Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. J Neurosurg 56:753-65 CrossRef
  8. Pool JL (1961) Aneurysms of the anterior communicating artery. J Neurosurg 18:98-12 CrossRef
  9. Taylor CL, Selman WR, Kiefer SP, Ratcheson RA (1996) Temporary vessel occlusion during intracranial aneurysm repair. Neurosurgery 39:893-05
  10. Frech R, Pasqualin A, Pinna G, Chioffi F, Bricolo A (2002) Temporary arterial occlusion in the repair of ruptured intracranial aneurysms: an analysis of risk factors for stroke. J Neurosurg 97:836-42 CrossRef
  11. Goldman MS, Anderson RE, Meyer FB (1992) Effects of intermittent reperfusion during temporal focal ischemia. J Neurosurg 77:911-16 CrossRef
  12. Charbel FT, Ausman JI, Diaz FG, Malik GM, Dujovny M, Sanders J (1991) Temporary clipping in aneurysm surgery: technique and results. Surg Neurol 36:83-0 CrossRef
  13. Tsementzis SA, Hitchocock ER (2001) Outcomes from “rescue clipping-of surgical experience on the rate of intraoperative aneurysm rupture and its impact on aneurysm treatment outcome. Surg Neurol 56:151-58 CrossRef
  14. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1- CrossRef
  15. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage: a practical scale. Lancet 1:480-84 CrossRef
  16. Suzuki J, Kwak R, Okudaira Y (1979) The safe time limit of temporary clamping of cerebral arteries in the direct surgical treatment of intracranial aneurysm under moderate hypothermia. Tohoku J Exp Med 127:1- CrossRef
  17. Teasdale GM, Drake CG, Hunt W, Kassell N, Sano K, Pertuiset B, De Villiers JC (1988) A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry 51:1457 CrossRef
  18. Tomida S, Nowak TS Jr, Vass K, Lohr JM, Klatzo I (1987) Experimental model for repetitive ischemic attacks in the gerbil: the cumulative effect of repeated ischemic insults. J Cereb Blood Flow Metab 7:773-82 CrossRef
  19. Chandler JP, Getch CC, Batjer HH (1998) Intraoperative aneurysm rupture and complication avoidance. Neurosurg Clin N Am 9:861-68
  20. Sandalcioglu IE, Schoch B, Regel JP, Wanke I, Gasser T, Forsting M, Stolke D, Wiedemayer H (2004) Does intraoperative aneurysm rupture influence outcome? Analysis of 169 patients. Clin Neurol Neurosurg 106:88-2 CrossRef
  21. van Lindert EJ, B?cher-Schwarz HG, Perneczky A (2001) The influence of surgical experience on the rate of intraoperative aneurysm rupture and its impact on aneurysm treatment outcome. Surg Neurol 56:151-58 CrossRef
  22. Houkin K, Kuroda S, Takahashi A, Takikawa S, Ishikawa T, Yoshimoto T, Itamato K (1999) Intra-operative premature rupture of the cerebral aneurysms. Analysis of the causes and management. Acta Neurochir (Wien) 141:1255-263 CrossRef
  23. Ogilvy CS, Carter BS, Kaplan S, Rich C, Crowell RM (1996) Temporary vessel occlusion for aneurysm surgery: risk factors for stroke in patients protected by induced hypothermia and hypertension and intravenous mannitol administration. J Neurosurg 84:785-91 CrossRef
  24. Fridriksson S, S?veland H, Jakobsson KE, Edner G, Zygmunt S, Brandt L, Hillman J (2002) Intraoperative complications in aneurysm surgery: a prospective national study. J Neurosurg 96:515-22 CrossRef
  25. Samson D, Batjer HH, Bowman G, Mootz L, Krippner WJ Jr, Meyer YJ, Allen BC (1994) A clinical study of the parameters and effects of temporary arterial occlusion in the management of intracranial aneurysms. Neurosurgery 34:22-8 CrossRef
  26. Ljunggren B, Saveland H, Brandt L, Kagstrom E, Rehncrona S, Nilsson PE (1983) Temporary clipping during early operation for ruptured aneurysm: preliminary report. Neurosurgery 12:525-30 CrossRef
  27. Ogawa A, Sato H, Sakurai Y, Yoshimoto T (1991) Limitation of temporary vascular occlusion during aneurysm surgery. Study by intraoperative monitoring of cortical blood flow. Surg Neurol 36:453-57 CrossRef
  28. Ohmoto T, Nagao S, Mino S, Fujiwara T, Honma Y, Ito T, Ohkawa M (1991) Monitoring of cortical blood flow during temporary arterial occlusion in aneurysm surgery by the thermal diffusion method. Neurosurgery 28:49-4 CrossRef
  
• 作者单位：Sivashanmugam Dhandapani (1)
  Sudhir S. Pal (1)
  Sunil K. Gupta (1) (3)
  Sandeep Mohindra (1)
  Rajesh Chhabra (1)
  Surender K. Malhotra (2)
  
  1. Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  3. Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
  2. Department of Anesthesiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  

文摘

Background 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. Methods 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. Results 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-lt;-.001). Aneurysms complicated by IAR had significantly longer clipping time (8.3?min) compared with those without IAR (1.9?min) (p-lt;-.001). IAR had significant association with unfavorable outcome (38?% vs. 24?%) (p--.02). Patients with ETC had significantly shorter clipping time (2.9?min) compared with those without ETC (4.8?min) (p--.02). Unfavorable outcome was noted in 30 out of 132 with ETC (23?%), compared with 48 out of 141 without ETC (34?%) (p--.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--.048) and total clipping time of at least 20?min (75?% unfavorable outcome, p--.008) had significant impact on outcome. In multivariate analysis, the use of ETC (p--.027) and total temporary clipping less than 20?min (p--.049) were noted to result in significantly better outcome, independent of other factors. Conclusions 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.