title: The impact of temporary artery occlusion during intracranial aneurysm surgery on long-term clinical outcome: Part II. The patient who undergoes elective clipping.
abstract: BACKGROUND
  Temporary artery occlusion (TAO) during intracranial aneurysm surgery is a key element in facilitating aneurysm dissection and clipping. Despite its significance, knowledge of its effects on long-term clinical outcome in patients undergoing elective clipping for unruptured aneurysms is limited. This study evaluated the safety of this technique in this patient population by 1 surgeon.
  
  
  METHODS
  Patients managed for an intracranial aneurysm were followed from 2000-2009. This study included a cohort of patients found to have unruptured intracranial aneurysms who underwent TAO during their elective clipping procedure. Potential risk factors to affect outcome were considered. Effects of TAO on long-term clinical outcome were evaluated using the Glasgow Outcome Scale (GOS) obtained retrospectively by analyzing medical records at the last follow-up visit or discharge. Analyses included descriptive statistics, binary logistic regression, and ordinal logistic regression.
  
  
  RESULTS
  Inclusion criteria were met by 246 patients (75.2% female, age 54 years±10.9) with electively clipped, unruptured aneurysms. Mean follow-up was 53 months±67.5. Mean temporary artery clipping time was 16.1 minutes±14.7. Of patients, 86% had a good outcome and made a complete recovery at last follow-up (GOS 5); 9% of patients were moderately disabled (GOS 4); 5% of patients were severely disabled (GOS 3), were in a vegetative state (GOS 2), or had died (GOS 1). TAO time had no effects on overall long-term clinical outcomes (P=0.59). Although patients with posterior circulation aneurysms had a worse outcome compared with patients with anterior circulation aneurysms (P=0.008), age (P=0.176) and aneurysm size (P=0.497) were not significantly associated with clinical outcome.
  
  
  CONCLUSIONS
  This study did not demonstrate any relationship between limited duration of TAO and clinical outcome. Posterior circulation aneurysms are associated with worse long-term clinical outcomes in patients with electively clipped, unruptured aneurysms.
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Tyler L
authors.initials: TL
authors.lastname: Poston
authors.affiliation: Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA.
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Mortazavi
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Falola
authors.affiliation: Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA. Electronic address: shane.tubbs@chsys.org.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Winfield S
authors.initials: WS
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Elective aneurysm clipping; Temporary artery occlusion