Use of our protocol of multimodality tools to aid in the safe microsurgical clipping of unruptured anterior circulation aneurysms

Satish Kannan; Yasuhiro Yamada; Kyosuke Miyatani; Takao Teranishi; Arun Marathi; Krishna Mohan; Tsukasa Kawase; Yoko Kato

doi:10.4103/ajns.AJNS_65_19

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 773-779
DOI: 10.4103/ajns.AJNS_65_19

Original Article

Use of our protocol of multimodality tools to aid in the safe microsurgical clipping of unruptured anterior circulation aneurysms

Authors

Satish Kannan

Department of Neurosurgery, Institute of Neurosciences and Spinal Disorders, MGM Health Care, Chennai, Tamil Nadu
Yasuhiro Yamada

¹Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
Kyosuke Miyatani

¹Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
Takao Teranishi

¹Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
Arun Marathi

²Department of Neurosurgery, Prathima Hospitals, Hyderabad, Telangana
Krishna Mohan

³Department of Neurosurgery, KIMS, Nellore, Andhra Pradesh
Tsukasa Kawase

¹Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
Yoko Kato

¹Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya

Abstract

Objectives: The aim of this study is to analyze the effectiveness of our protocol of the use of multimodality tools, namely indocyanine green-dual image video angiography, neuroendoscope, neuromonitoring with motor-evoked potential, micro-Doppler in the microsurgical clipping of unruptured anterior circulation aneurysms, operated at our institute from January 2016 to December 2018. Materials and Methods: We performed a retrospective analysis of all cases of unruptured anterior circulation aneurysms, operated at Fujita Health University Banbuntane-Hotokukai Hospital, Japan, from January 2016 to December 2018. We assessed outcome at immediate postoperative, at discharge, and at 3 months follow-up by defining permanent morbidity as drop in Modified Rankin Scale (MRS) by 1 at 3 months follow-up and transient morbidity as temporary deficit that improved at discharge or follow-up. Postoperative events, namely seizures, infection that did not affect/change. Preoperative MRS and discharge timing were excluded. We concluded poor outcome as MRS ≥3 and good outcome as MRS < 3 (0–2). All patients had a minimum of 3 months follow-up before outcome conclusion. Results: In 2016, a total of 98 cases were operated with no mortality or permanent morbidity (i.e., change in preoperative MRS), only transient morbidity was seen in (two cases) 2.04%. In 2017, a total of 119 cases were operated with no mortality or morbidity. In 2018, a total of 130 cases were operated with no mortality or permanent morbidity, only transient morbidity 0.7%. Summarizing from January 2016 to December 2018, a total of 347 cases of anterior circulation aneurysms were operated. Mostly, in the female sex (73.3%), the most common was middle cerebral artery aneurysm (39.1%). The mean size was 5.3 mm with no mortality or permanent morbidity with only transient morbidity in 0.9%. No poor outcome (MRS ≥3) was seen in our series. Conclusion: In our center for most unruptured anterior circulation aneurysms, microsurgical clipping is the treatment of choice. We believe our protocol of the intra-operative usage of multimodality tools have aided in the safe microsurgical clipping and have consistently resulted in good operative outcomes. Hence, we recommend and continue to use our Fujita-Bantane Protocol in all cases of micro-surgical clipping of aneurysms to consistently achieve good operative outcomes.

Key-words:

Anterior circulation aneurysms - dual image video angiography - incidental aneurysms - indo-cyanine green - motor-evoked potentials - neuro-endoscope - neuro-monitoring - safe clipping - surgical outcome - unruptured aneurysms

Full Text

References

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