gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Article

Send article

Postoperative cerebral ischemia after temporary occlusion in anterior communicating artery aneurysms

Postoperative zerebrale Ischämie nach temporärer Okklusion bei Arteria communicans anterior Aneurysmata

Meeting Abstract

Search Medline for

  • presenting/speaker Ondra Petr - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
  • Christian Preuss-Hernandez - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
  • Philipp Geiger - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
  • Aleksandrs Krigers - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
  • Claudius Thomé - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV102

doi: 10.3205/22dgnc104, urn:nbn:de:0183-22dgnc1046

Published: May 25, 2022

© 2022 Petr 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

Text

Objective: Temporary arterial clipping (TAO) of A1 segments for ACOM aneurysm surgical treatment is a widely used technique. It remains unclear for how long the A1 occlusion is safe or whether the A1 dominance plays a role in cerebral ischemia incidence after using this technique. We aimed to investigate the safety and outcomes of TAO strategies in ACOM aneurysms.

Methods: All cases of surgically treated ACOM aneurysms from 2010 to 2020 were retrospectively analyzed. Demographic, clinical data and detailed information regarding the surgery and TAO (i.e., length for ipsilateral, contralateral and dominant A1 segments, side of craniotomy, vasospasm, presence of postoperative cerebral ischemia) were retrospectively collected.

Results: In total, 162 patients were analyzed, 54 (33%) treated for unruptured and 108 (67%) for ruptured ACOM aneurysm. Cerebral ischemia occurred in 30% (34/115) patients after TAO compared to 11% (5/44) w/o TAO (p=0.017). In patients with unruptured ACOM-aneurysms, all 6 cases of ischemia were associated with TAO. Subarachnoid hemorrhage (p=0.008) and cerebral vasospasms (p=0.006) increased the odds for postoperative cerebral ischemia. Both single maximal and total summated time of intermittent TAO were related to ischemia in case of A1 occlusion ipsilateral to craniotomy (p=0.009 and p=0.014, respectively). The odds for cerebral ischemia increased of 5% pro minute for single maximal TAO time in logistical regression (OR 1.051, CI95% 1.006-1.097; p=0.025). According to ROC-curve, the cut-off for safe TAO of ipsilateral A1 was 12.5 minutes (sensitivity 0.56, specificity 0.77, AUC 0.684). The safe total summated time of intermittent ipsilateral A1 TAO was between 11.1 to 20.5 minutes without any definite cut-off point according to Youden index (AUC 0.685). TAO of contralateral or dominant A1, or side of craniotomy did not correlate with postoperative cerebral ischemia.

Conclusion: Prolonged TAO of ipsilateral A1 more than 12.5 minutes appears to be hazardous due to postoperative cerebral ischemia. Similarly, a total summated TAO time of longer than 21 minutes should be avoided. Referring the postoperative cerebral ischemia, TAO of contralateral A1, A1 dominance or side of craniotomy are of peripheral importance.