Association between early stenosis and temporary clipping in treated cerebral aneurysms
Main Article Content
Keywords
Intracranial Aneurysm, Brain, Constriction, Pathologic, Anterior Cerebral Circulation, Temporary Clipping
Abstract
Abstract
Background: Postoperative vascular stenosis following the use of temporary clips in cerebral aneurysms represents a current challenge due to the limited available evidence. This study evaluated whether temporary clipping causes significant image-detected stenosis and whether associated factors contribute to its occurrence.
Objective: To determine the presence of early postoperative vascular stenosis related to the use of temporary clips in patients undergoing neurosurgical treatment for cerebral aneurysms.
Material and methods: A cross-sectional analytical study was conducted in 43 patients surgically treated for cerebral aneurysms. Clinical and surgical variables were recorded, comparing pre- and postoperative vascular calibers using a paired Student’s t-test. The frequency of residual aneurysm and associations with clip type, clinical factors, and clipping time were analyzed.
Results: A significant reduction in postoperative vascular caliber was identified (mean 5.2%, p = 0.007). No statistically significant associations were found between stenosis and the evaluated factors. The incidence of residual aneurysm was low, and clipping times remained within safe parameters.
Conclusions: Temporary clipping proved to be a safe and effective procedure, with a low rate of significant stenosis and no relationship with clinical or technical variables. Continued imaging follow-up and multicenter studies are recommended to confirm these findings.
References
1. Fareed Jumah, Quinoa T, Omar A, et al. The origins of eponymous aneurysm clips: A review. World Neurosurg. 2019.
2. Teping F, Fischer G, Huelser M, et al. A new clip generation for microsurgical treatment of intracranial aneurysm - The first case series. World Neurosurg. 2019. doi:10.1016/j.wneu.2019.06.023.
3. Quezada H, Arenas J, Gómez L, et al. Aneurismas cerebrales. Localización más frecuente en pacientes mexicanos estudiados en el hospital de especialidades del Centro Médico Nacional La Raza. An Radiol Mex. 2008;3:167-173.
4. Osborn AG. Diagnostic cerebral angiography. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2005. Section I: Normal gross and angiographic anatomy of the craniocervical vasculature. Chapter 3,4 p.57–104. Chapter 9 p.173–193.
5. Rothon LR. Anatomía craneal y abordajes quirúrgicos. 2nd ed. Caracas: Editorial Amolca; 2021. Parte 2. Capítulo 2 p.81–148.
6. Pontes FGDB, Da Silva EMK, Baptista-Silva JCC, et al. Treatments of unruptured intracranial aneurysms. Cochrane Database Syst Rev. 2021;(5):CD013312. doi:10.1002/14651858.
7. Ni W, Yang H, Xu B, et al. Proximal middle cerebral artery aneurysm: Microsurgical management and therapeutics results. World Neurosurg. 2018. doi:10.1016/j.wneu.2018.10.174.
8. Slang LK, Zhang JY, Nguyen V, et al. The evolution of intracranial aneurysm treatment techniques and future directions. Neurosurg Rev. 2022;45:1–25. doi:10.1007/s10143-021-01543-z.
9. Muirhead WR, Horsfall HL, Khan DZ, et al. Microsurgery for intracranial aneurysm: A qualitative survey of technical challenges and technological solutions. Front Surg. 2022;9:957459. doi:10.3389/fsurg.2022957450.
10. Lawton MT. Seven aneurysm, Tenets and techniques for clipping. New York: Thieme Medical Publishers, Inc.; 2011. Section I: The tenets. Chapter 5: Temporary Clipping p.14-15.
11. Kumar S, Sahana D, Menon G. Optimal use of temporary clip application during aneurysm surgery - In search of the holy grail. Asian J Neurosurg. 2021;16:237–42.
12. Tanabe J, Ishikawa T, Moroi J. Safe time duration of temporary middle cerebral artery occlusion in aneurysm surgery based on motor evoked potential monitoring. Surg Neurol Int. 2017. doi:10.4103/sni.sni_410_16.
13. Griessenauer JC, Poston TL, Shoja MA, et al. The impact of temporary artery occlusion during intracranial aneurysm on long-term clinical outcome. World Neurosurg. 2014. doi:10.1016/j.wneu.2013.02.067.
14. Marbacher S, Kienzler JC, D´Alonzo D, et al. Comparison of intra and postoperative 3-dimensional digital subtraction angiography in evaluation of the surgical result after intracranial aneurysm treatment. Neurosurgery. 2019. doi:10.1093/neuros/nyz487.
15. Kim JJ, Chun CK, Hyun SS, et al. Evaluation of the angiographic outcomes after clipping of intracranial aneurysm: Determination of predisposing factors for occurrence of aneurysm remnants. Neurol Res. 2020. doi:10.1080/01616412.2020.1732594.
16. Obermueller K, Hostettler I, Wagner A, et al. Frequency and risk factors for postoperative aneurysm residual after microsurgical clipping. Acta Neurochir (Wien). 2020. doi:10.1007/s00701-020-04639-5.
17. Marbacher S, Halter M, Vogt D, et al. Value of 3-Dimensional digital subtraction angiography for detection and classification of intracranial aneurysm remnants after clipping. Oper Neurosurg (Hagerstown). 2021;21(2).
18. Inci S, Akbay A, Asian T. The longest angiographic and clinical follow-up of microsurgically treated giant intracranial aneurysms: Experience with 70 cases. World Neurosurg. 2019. doi:10.1016/j.wneu.2019.10.085.
19. Malinova V, Schatlo B, Voit M, et al. The impact of temporary clipping during aneurysm surgery on the incidence of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2018;129. doi:10.31171/2017.3.JNS.162505.
20. Hsiang S, Chou Y. Subarachnoid hemorrhage. Continuum (Minneap Minn). 2021;27(5):1201–1245.
21. Goertz L, Hamisch C, Kabbasch C, et al. Impact of aneurysm shape and neck configuration on cerebral infarction during microsurgical clipping of intracranial aneurysm. J Neurosurg. 2019. doi:10.3171/2019.1.JNS183193.
22. Swiatnicki W, Szymanski J, Szymariska A, et al. Predictors of intraoperative aneurysm rupture, aneurysm remnant, and brain ischemia following microsurgical clipping of intracranial aneurysms: Single-center, retrospective cohort study. J Neurol Surg A Cent Eur Neurosurg. 2021. doi:10.1055/s-0040-1721004.
23. Silva PA, Días C, Vilarin A, et al. The effects of temporary clipping as an expression of circulatory individuality: Online measurement of temporal lobe oxygen levels during surgery of middle cerebral artery aneurysm. World Neurosurg. 2021;152:E765–E775.
24. Pasqualin A, Meneghelli P, Musumeci A, et al. Intraoperative measurement of arterial blood flow in aneurysm surgery. Acta Neurochir Suppl. 2018;129:77–81. doi:10.1007/978-3-319-73739-3_7.
25. Mohsin M, Shaikh N, Yousaf Z, et al. Risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage: A tertiary care center experience. Asian J Neurosurg. 2022;17. doi:10.1055/s-0042-1750838.
26. Páez D, Parrilla G, Díaz J, et al. Are modified Fisher scale and bleeding pattern helpful predictors of neurological complications in non-aneurysmal subarachnoid hemorrhage? Interv Neuroradiol. 2020. doi:10.1007/s00234-020-02524-7.
Article Sidebar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.