title: [Surgical stress in patients with asymptomatic unruptured intracranial aneurysms].
abstract: BACKGROUND
  Surgical stress elicits a characteristic response involving induction of synthesis and release of acute-phase proteins such as C-reactive protein (CRP). To objectively evaluate the surgical stress in patients with asymptomatic unruptured intracranial aneurysms, serum levels of CRP after direct clipping via the pterional approach were measured.
  
  
  METHODS
  42 patients who experienced an uneventful postoperative course, were evaluated according to age (less or more than 65 years old [adult or elderly]), aneurysmal location (middle cerebral artery territory [MC], anterior communicating artery [Acom] or internal carotid artery territory [IC]) and intraoperative trauma (positive or negative). We defined intraoperative trauma as intentional vein cutting, perforator vessel injury or suction of the gyrus rectus. All patients received standardized general anesthesia and were treated after the operations according to our standard protocols. Serum levels of CRP on postoperative day 2 were compared in each category.
  
  
  RESULTS
  Serum levels of CRP showed no significant difference between the adult group and the elderly group, but were greater in Acom patients than in MC and IC patients (p < 0.01, p < 0.05). As to intraoperative traumas, the positive group (almost all were intentional vein cutting) showed greater CRP levels than the negative group in MC and IC patients (p < 0.05). Operation time and volume of blood loss were almost the same in each category.
  
  
  CONCLUSIONS
  Our study shows that as far as serum levels of CRP are concerned, Acom location and vein cutting are the main factors of surgical stress in cases of unruptured aneurysms.
authors.affiliation: Department of Neurosurgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Ishiguro
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Yasui
authors.forename: Tosie
authors.initials: T
authors.lastname: Morikawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Matsusaka
authors.forename: Masaki
authors.initials: M
authors.lastname: Komiyama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Iwai
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood* / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014656:Vascular Surgical Procedures / Q000379:methods
chemical_list: D002097:C-Reactive Protein