[An evaluation of temporary clipping during aneurysmal surgery: a retrospective study].
A temporary clipping of a parent artery has been found convenient in facilitating an aneurysmal dissection. This is because it controls the bleeding from an unexpected rupture and keeps the sac collapsed during the operation. Such a temporary arterial occlusion, however, involves the risk of a focal ischemia that may lead to permanent postoperative neurological deficits. Therefore, to evaluate the influence of a temporary clipping on the outcome of an operation, a retrospective study of 302 patients who underwent an operation for a ruptured supratentorial aneurysm between 1981 and 1990 has been conducted. This study has revealed the information that follows: 1) Overall outcomes In patients given no temporary clipping, their postoperative activity in daily living (ADL) grade was good in 70.7%, i.e. ADL 1 or 2, whereas only 46.4% of the patients given a temporary clipping achieved a similar ADL. 2) Influence of the preoperative Hunt and Kosnik neurological classification on the outcome Irrespective of whether a temporary clip had been used, patients with a Hunt and Kosnik grade of 1 or 2 made a good recovery, whereas patients with a grade of 4 or 5 did not. The application of a temporary clip in grade 3 patients led to a poor result, whereas in grade 3 patients given no temporary clipping the results were good. This would seem to indicate that Hunt and Kosnik grade 3 rating is a critical factor in consideration whether a temporary clip should be used or not. 3) Influence of the operative timing on the outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
Kubota
S
S
Department of Neurosurgery, Saitama Medical School.
Tatara
N
N
Miyoshi
A
A
Nagashima
C
C
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D002536:Cerebral Arteries; D003250:Constriction; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors