An evaluation of temporary clipping during aneurysmal surgery: a retrospective study
Kubota, S.; Tatara, N.; Miyoshi, A.; Nagashima, C.
No Shinkei Geka. Neurological Surgery 20(12): 1247-1254
1992
ISSN/ISBN: 0301-2603 PMID: 1484591 Document Number: 395829
A temporary clipping of a parent artery has been found convenient in facilitating an aneurysmal dissection. This is because it controls the bleeding from an unexpected rupture and keeps the sac collapsed during the operation. Such a temporary arterial occlusion, however, involves the risk of a focal ischemia that may lead to permanent postoperative neurological deficits. Therefore, to evaluate the influence of a temporary clipping on the outcome of an operation, a retrospective study of 302 patients who underwent an operation for a rupture supratentorial aneurysm between 1981 and 1990 has been conducted. This study has revealed the information that follows. In patients given no temporary clipping, their postoperative activity in daily living (ADL) grade was good in 70.70%, i.e. ADL 1 or 2, whereas only 46.4% of the patients given a temporary clipping achieved a similar ADL. Irrespective of whether a temporary clip had been used, patients with a Hunt and Kosnik grade of 1 or 2 made a good recovery, whereas patients with a grade of 4 or 5 did not. The application of a temporary clip in grade 3 patients led to a poor result, whereas in grade 3 patients given no temporary clipping the results were good. This would seem to indicate that Hunt and Kosnik grade 3 rating is a critical factor in consideration whether a temporary clip should be used or not. The application of a temporary clip during the acute stage (Day 0 to 3 after SAH) led to a poor result, whereas the recovery was good in patients given no temporary clipping. The patients in the subacute stage (Day 4 to 13) and in the chronic stage (over Day 14), regardless of temporary clipping, made a good recovery. Poor results were found in patients with an occlusion time of more than 15 minutes. In patients with repeated applications of a temporary clip, the postoperative results were poor, whereas a good recovery was achieved by patients with a single application. In four out of 64 patients (6.3%), postoperative angiogram showed a narrowing at the site of the clip application, and 3 of four patients subsequently expired due to brain ischemia with edema. These findings suggest that the use of a temporary clip may lead to a poor outcome, especially in patients operated on in the acute stage (Day 0 to 3) and with grade 3 of Hunt and Kosnik classification.