A Study on the Effect of Temporary Clipping on Surgical Outcome of Cerebral Aneurysms

ABSTRACT

The author analyzed the postoperative results in 96 patients who underwent temporary clipping during cerebral aneurysm surgery from July, 1990 to April, 1995. 1) The overall outcome were as followsexcellent(55.2%), good(21.9%), poor(16.7%), dead(6.3%) and its results were relatively similar to those of the patients who did not have the temporary clipping. 2) The patients were divided into 4 groups according to the site of the temporary clip application. The safe durations of temporary clipping were as followsIn the 1) anterior cerebral artery clipping group, 5 minutes for Hunt-Hess grade 1 & 2 patients and 2 minutes and 30 seconds for Hunt-Hess grade 3 & 4 patients, In the 2) middle cerebral artery clipping group, 5 minutes;In the 3) internal carotid artery clipping group, 5 minutes in Hunt-Hess grade 1 & 2 and 2 minutes for Hunt-Hess grade 3 & 4;The only one patient in the 4) basilar artery clipping group showed excellent outcome after 3 minutes of temporary clipping. Therefore, we concluded that the temporary clipping tecnique would be very useful to dissect the aneurysmal neck, to prevent and control the premature rupture without influencing the outcome. Furthermore, use of the cerebral protective agent, intraoperative cerebral blood flow monitoring and avoidance of excessive and prolonged hypotension during cerebral aneurysm surgery might be very helpful for preventing the cerebral ischemia and increasing the safety duration of the temporary clipping.