Available online 14 March 2013
Publication year: 2013
Source:World Neurosurgery
Introduction Temporary artery occlusion during intracranial aneurysm surgery is a key element in facilitating aneurysm dissection and clipping. Despite its significance, knowledge of its effects on long-term clinical outcome in patients undergoing elective clipping for unruptured aneurysms is limited. This study evaluated safety of this technique in this patient population by one surgeon. Methods Patients managed for an intracranial aneurysm were followed from 2000 to 2009. This study included a cohort of patients found to have unruptured intracranial aneurysms that underwent temporary artery occlusion during their elective clipping procedure. Potential risk factors to affect outcome were considered. Effects of temporary artery occlusion on long-term clinical outcome were evaluated using the Glasgow outcome score (GOS) obtained retrospectively by analyzing medical records at the last follow up visit or discharge. Analyses included descriptive statistics, binary logistic and ordinal logistic regression. Results Two hundred and forty six patients (75.2% female, age 54 years ± 10.9) with electively clipped, unruptured aneurysms met inclusion criteria. Mean follow up was 53 months ± 67.5. Mean temporary artery clipping time was 16.1 ± 14.7 min. Eighty six percent of patient had a good outcome and made a complete recovery at last follow up (GOS 5). Nine percent of patients were moderately disabled (GOS 4). Five percent of patients were either severely disabled, in a vegetative state, or had died (GOS 3, 2, and 1, respectively). Overall, temporary artery occlusion time had no effects on overall long-term clinical outcomes (p=0.59). While patients with posterior circulation aneurysms had a worse outcome compared to those with anterior circulation aneurysms (p=0.008), age (p=0.176) or aneurysm size (p=0.497) were not significantly associated with clinical outcome. Conclusions This study did not demonstrate any relationship between limited duration of temporary artery occlusion and clinical outcome. Posterior circulation aneurysms are associated with worse long-term clinical outcomes in patients with electively clipped, unruptured aneurysms.
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