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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2020; 9(02): 075-079
DOI: 10.1055/s-0039-3402625
Original Article

Evaluation of Ischemia Following Clipping of Anterior Circulation Aneurysms with Respect to Temporary Clipping Using Diffusion-Weighted Magnetic Resonance Imaging: A Prospective Study

Pankaj Kumar
1   Department of Neurosurgery, Dr. Ram Manohar Lohia Hospital Hospital, New Delhi, India
,
Shaam Bodeliwala
2   Department of Neurosurgery, G.B. Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
,
Rajender Aher
3   Medipulse Hospital, Basni Phase II, Jodhpur, Rajasthan, India
,
Anita Jagetia
2   Department of Neurosurgery, G.B. Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
,
Arvind Kumar Srivastava
2   Department of Neurosurgery, G.B. Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
,
Daljit Singh
2   Department of Neurosurgery, G.B. Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
,
Pragati Ganjoo
2   Department of Neurosurgery, G.B. Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
› Author Affiliations Disclosure of Funding The authors do not have any conflict of interest, commercial associations, or financial support/grants from any organization for this study.
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Abstract

Temporary vessel occlusion enables a surgeon dissect aneurysm and clip with a lower risk of intraoperative hemorrhage with the associated risk of ischemia. There are studies on permissible time of occlusion of the parent artery using temporary clip; however, the actual incidence of silent ischemic events in patients with aneurysms treated with microsurgical clipping is not well documented. We are trying to look for the association between temporary clipping and incidence of ischemia through this study. The study concluded the statistically significant association between the maximum time of single clip application and ischemia. Intermittent multiple temporary clippings can prevent ischemia instead of a single clipping of longer duration.

Keywords

aneurysm - cerebral infarction - intraoperative hemorrhage


Publication History

Article published online:
17 February 2020

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  • References

  • 1 Adams Jr HP, Kassell NF, Torner JC, Haley Jr EC. Predicting cerebral ischemia after aneurysmal subarachnoid hemorrhage: influences of clinical condition, CT results, and antifibrinolytic therapy. A report of the Cooperative Aneurysm Study. Neurology 1987; 37 (10) 1586-1591
    CrossrefPubMedGoogle Scholar
  • 2 Juvela S, Siironen J, Kuhmonen J. Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage. J Neurosurg 2005; 102 (06) 998-1003
    Google Scholar
  • 3 Krayenbühl N, Erdem E, Oinas M, Krisht AF. Symptomatic and silent ischemia associated with microsurgical clipping of intracranial aneurysms: evaluation with diffusion-weighted MRI. Stroke 2009; 40: 129-133
    CrossrefPubMedGoogle Scholar
  • 4 Ferch R, Pasqualin A, Pinna G, Chioffi F, Bricolo A. Temporary arterial occlusion in the repair of ruptured intracranial aneurysms: an analysis of risk factors for stroke. J Neurosurg 2002; 97 (04) 836-842
    CrossrefPubMedGoogle Scholar
  • 5 Cronqvist M, Wirestam R, Ramgren B. et al. Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results, MR findings and clinical outcome. Neuroradiology 2005; 47 (11) 855-873
    CrossrefPubMedGoogle Scholar
  • 6 Samson D, Batjer HH, Bowman G. et al. A clinical study of the parameters and effects of temporary arterial occlusion in the management of intracranial aneurysms. Neurosurgery 1994; 34 (01) 22-28, discussion 28–29
    PubMedGoogle Scholar
  • 7 Selvapandian S, Sudarsan PS, Shaji PG, Chandy MJ. Elective intermittent temporary clipping in aneurysm surgery: a practical protocol. Indian J Neurosurg 2015; 04: 8-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Ogilvy CS, Carter BS, Kaplan S, Rich C, Crowell RM. Temporary vessel occlusion for aneurysm surgery: risk factors for stroke in patients protected by induced hypothermia and hypertension and intravenous mannitol administration. J Neurosurg 1996; 84 (05) 785-791
    CrossrefPubMedGoogle Scholar