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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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The influence of elective and rescue temporary clipping during aneurysm surgery on the incidence of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

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  • Vesna Malinova - Klinik für Neurochirurgie, Georg-August-Universität Göttingen, Germany
  • Bawarjan Schatlo - Klinik für Neurochirurgie, Georg-August-Universität Göttingen, Germany
  • Martin Voit - Klinik für Neurochirurgie, Georg-August-Universität Göttingen, Germany
  • Patricia Suntheim - Klinik für Neurochirurgie, Georg-August-Universität Göttingen, Germany
  • Veit Rohde - Klinik für Neurochirurgie, Georg-August-Universität Göttingen, Germany; Klinik für Neurochirurgie, RWTH Aachen, Germany
  • Dorothee Mielke - Klinik für Neurochirurgie, Georg-August-Universität Göttingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.16.01

doi: 10.3205/16dgnc328, urn:nbn:de:0183-16dgnc3286

Published: June 8, 2016

© 2016 Malinova et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Temporary clipping (TC) is a commonly employed technique in surgery for ruptured intracranial aneurysms. Premature re-rupture may mandate TC as a rescue measure. On the other hand, “elective” TC may be useful to obtain proximal control during aneurysm dissection. The benefits of this technique are to be weighed against the risk of ischemia and risk of vasospasm by mechanical manipulation of the clipped vessel(s). The aim of this study was to evaluate the impact of “elective” and “rescue” TC on the incidence of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (aSAH).

Method: This retrospective analysis is based on 778 surgically treated patients with aSAH. Outcome variables included delayed cerebral vasospasm diagnosed by transcranial Doppler (TCD), delayed ischemic neurological deficits (DINDs) and cerebral infarction. Binary regression analysis was applied to evaluate the impact of TC. The effect size was corrected for age, sex, aneurysm location and World Federation of Neurosurgical Societies (WFNS) score.

Results: Mean age was 54 years (range 16-87) with 33.6% (261/778) male patients. TC was employed in 40.5% of all patients (n=315). In 69% (217/315) patients TC was elective, and in 31% (98/315) patients necessary due to intraoperative aneurysm rupture. The overall incidence of TCD-vasospasm, DINDs and infarction was 47.6% (370/778), 15.8% (123/778) and 12.5% (97/778) respectively. TCD-vasospasm occurred in 45.5% (210/463) of the patients without TC compared to 50.8% (160/315) in the patents with TC (p=0.14). The incidence of DINDs was higher in the patients without TC (18.2% [84/463]) vs. 12.4% [39/315]; p=0.036). Infarction developed more often in the group without TC (14.5% [67/463] vs. 9.5% [30/315]; p=0.046). The subanalysis of elective or rescue TC did not reveal additional associations with either outcome measure.

Conclusions: Interestingly, there was an association between TC and a lower incidence of DINDs as well as of infarction. However, we could not identify a specific subtype of TC, be it elective or rescue clipping, as a predictor for ischemia or neurological deficits. Hypothetically, temporary clip application in aneurysm surgery may induce the molecular preconditioning cascade known from experimental ischemia studies which may increase the metabolic threshold for ischemic injury.