Risk of stroke with temporary arterial occlusion in patients undergoing craniotomy for cerebral aneurysm.
OBJECTIVE
This study was performed to elucidate the technical and patient-specific risk factors for postoperative ischemia in patients undergoing temporary arterial occlusion (TAO) during the surgical repair of their aneurysms.


METHODS
Eighty-nine consecutive patients in whom TAO was performed during surgical repair of an aneurysm were retrospectively analyzed. The demographics of the patients were analyzed with respect to age, Hunt and Hess grade on admission, Fisher grade of hemorrhage, aneurysm characteristics, timing of surgery, duration of temporary occlusion, and number of temporary occlusive episodes. Outcome was analyzed at the 3-month follow-up, along with the occurrence of symptomatic and radiological stroke.


RESULTS
In overall, twenty-seven patients (29.3%) had radiologic ischemia attributable to TAO and fifteen patients (16.3%) had symptomatic ischemia attributable to TAO. Older age and poor clinical grade were associated with poor clinical outcome. There was a significantly higher rate of symptomatic ischemia in patients who underwent early surgery (p = 0.007). The incidence of ischemia was significantly higher in patients with TAO longer than 10 minutes (p = 0.01). In addition, patients who underwent repeated TAO, which allowed reperfusion, had a lower incidence of ischemia than those who underwent single TAO lasting for more than 10 minutes (p = 0.011).


CONCLUSIONS
Duration of occlusion is the only variable that needs to be considered when assessing the risk of postoperative ischemic complication in patients who undergo temporary vascular occlusion. Attention must be paid to the patient's age, grade of hemorrhage, and the timing of surgery. In addition, patients undergoing dissection when brief periods of temporary occlusion are performed may benefit more from intermittent reperfusion than continuous clip application. With careful planning, the use of TAO is a safe technique when used for periods of less than 10 minutes.
Ha
Sung-Kon
SK
Department of Neurosurgery, Korea University Medical Center, Seoul, Korea.
Lim
Dong-Jun
DJ
Seok
Bong-Gil
BG
Kim
Se-Hoon
SH
Park
Jung-Yul
JY
Chung
Yong-Gu
YG
Neurosurgery. 1991 Jul;29(1):83-8
1870692
Acta Neurochir (Wien). 1985;77(1-2):1-7
2994399
Neurosurgery. 1987 May;20(5):678-87
3601013
Neurosurgery. 1983 May;12(5):525-30
6866234
J Neurosurg. 1992 Dec;77(6):911-6
1432135
J Neurol Neurosurg Psychiatry. 1980 Oct;43(10):879-82
7441266
J Neurosurg. 1981 Jan;54(1):35-43
7463118
Lancet. 1975 Mar 1;1(7905):480-4
46957
Surg Forum. 1978;29:527-9
401247
J Neurosurg. 1996 Sep;85(3):410-8
8751625
J Neurosurg. 1988 Feb;68(2):234-40
3339439
Surg Neurol. 1991 Aug;36(2):83-90
1891760
J Neurosurg. 1994 Oct;81(4):554-9
7931589
Acta Neurochir (Wien). 1988;93(1-2):28-36
3414414
J Neurosurg. 1996 May;84(5):785-91
8622152
Neurosurgery. 1996 Nov;39(5):893-905; discussion 905-6
8905743
J Neurosurg. 1996 Nov;85(5):923-8
8893733
Surg Neurol. 1987 Apr;27(4):343-52
3824140
Surg Neurol. 1987 Jan;27(1):47-63
3787442
J Neurosurg. 2000 Aug;93(2):175-82
10930001
J Neurosurg. 1990 Jul;73(1):37-47
2191091
Neurosurgery. 1994 Jan;34(1):22-8; discussion 28-9
8121566
Trans Am Neurol Assoc. 1961;86:232-3
14487833
Neurosurgery. 1990 Jan;26(1):61-70
2294480
Clin Neurosurg. 1990;36:21-47
2403882
Neurosurgery. 1987 Sep;21(3):279-87
3670571