Surgical stress in patients with asymptomatic unruptured intracranial aneurysms
Ishiguro, T.; Yasui, T.; Morikawa, T.; Matsusaka, Y.; Komiyama, M.; Yamanaka, K.; Iwai, Y.
No Shinkei Geka. Neurological Surgery 31(1): 35-40
2003
ISSN/ISBN: 0301-2603 PMID: 12533903 Document Number: 555317
Surgical stress elicits a characteristic response involving induction of synthesis and release of acute-phase proteins such as C-reactive protein (CRP). To objectively evaluate the surgical stress in patients with asymptomatic unruptured intracranial aneurysms, serum levels of CRP after direct clipping via the pterional approach were measured. 42 patients who experienced an uneventful postoperative course, were evaluated according to age (less or more than 65 years old ) and intraoperative trauma (positive or negative). We defined intraoperative trauma as intentional vein cutting, perforator vessel injury or suction of the gyrus rectus. All patients received standardized general anesthesia and were treated after the operations according to our standard protocols. Serum levels of CRP on postoperative day 2 were compared in each category. Serum levels of CRP showed no significant difference between the adult group and the elderly group, but were greater in Acom patients than in MC and IC patients (p < 0.01, p < 0.05). As to intraoperative traumas, the positive group (almost all were intentional vein cutting) showed greater CRP levels than the negative group in MC and IC patients (p < 0.05). Operation time and volume of blood loss were almost the same in each category. Our study shows that as far as serum levels of CRP are concerned, Acom location and vein cutting are the main factors of surgical stress in cases of unruptured aneurysms.