[Temporary occlusion in surgical management of intracranial aneurysm. Report of 54 cases].
Temporary arterial occlusion (TAO) is commonly used in the surgery of intracranial giant aneurysms. Its usefulness and safety in the surgical management of all cases of aneurysms remains to be proved. We report a series of 54 patients operated on for an intracranial aneurysm with the use of TAO. Among the 27 patients, admitted before the 4th day following post subarachnoid hemorrhage with I or II on WFNS score clinically, 24 had early aneurysm surgery. The size of the aneurysm was small in 16 cases, medium in 22, large in 13 and giant in 3 cases. The protocol proposed by Batjer in 1988 for large and giant aneurysms (etomidate, normotention and hypervolemia) was used without any electrophysiological monitoring. All patients underwent a post-operative cerebral CT scan to evaluate the incidence of a cerebral ischemia. Serial transcranial doppler was used to evaluate the severity of vasospasm. Clinical results were assessed using the GOS. TAO was elective in 51 patients and done after peroperative aneurysm rupture in 3 patients. The duration of TAO was less than 5 mn in 25 patients, between 5 and 10 min in 12, between 10 and 15 in 11, between 15 and 20 in 5 and more than 20 min in one patient. The last one developed a reversible neurological deficit secondary to ischemia attribuated to TAO. Intracranial aneurysm peroperative rupture was noted in 3 patients, clinical vasospam in 13 patients. These results allow us to recommend the routine use of TAO in the surgery of intracranial aneurysm. When application time is limited and cerebral protection used, TAO is safe. It decreases the risk of intraoperative rupture from a 18% rate in literature to 4.2% in our present experience and the risk of symptomatic vasospasm is not increased.
Samaha
E
E
Service de Neurochirurgie, Hôtel-Dieu de France, Achrafieh, Beyrouth, Liban.
Rizk
T
T
Nohra
G
G
Mohasseb
G
G
Okais
N
N
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications; D013345:Subarachnoid Hemorrhage / Q000209:etiology
Le clampage temporaire réglé dans la chirurgie anévrismale intracrânienne. A propos de 54 cas.