Woertgen Chris, Rothoerl Ralf Dirk, Albert Ruth, Schebesch Karl-Michael, Ullrich Odo-Winfried
Department of Neurosurgery, University of Regensburg, Regensburg, Germany.
Neurol Res. 2008 Jun;30(5):542-6. doi: 10.1179/174313208X291603.
Intraoperative aneurysm rupture is associated with a high morbidity and mortality. Temporary vessel occlusion is an integral part of aneurysm clipping to avoid intraoperative hemorrhage. The information concerning the role of temporary occlusion regarding the development of cerebral vasospasm is sparse. The aim of this study was to provide more information in this field.
We operated on 292 patients suffering from cerebral aneurysms. The data were reviewed from a prospectively collected databank, which includes information about the severity of subarachnoid hemorrhage, as well as transcranial Doppler data and surgical data such as temporary occlusion.
In 50% of our patients, temporary occlusion was performed during surgery. Twenty-nine percent showed an ischemic lesion in the CCT post-operatively, and in 58% of these patients, temporary occlusion was performed (versus 47% without temporary occlusion, p = 0.09). The mean occlusion time was longer in patients with radiologic signs of infarction. Furthermore, patients having unfavorable outcome showed a longer temporary occlusion time. Thirty-four percent of patients who underwent temporary vessel occlusion developed vasospasm postoperatively (versus 20% without temporary occlusion, p < 0.006). Temporary occlusion time correlated to the development of vasospasm as defined by transcranial Doppler flow velocity. Forty-eight percent of the patients treated using temporary occlusion suffered from middle cerebral artery aneurysm (versus 22% without temporary occlusion, p < 0.0001). An increased blood flow velocity was mostly seen in this region (p < 0.003).
According to our results, it seems to be the possible that temporary vessel occlusion is an additional factor in aggravating vasospasm after aneurysmatic subarachnoid hemorrhage.
术中动脉瘤破裂与高发病率和死亡率相关。临时血管闭塞是动脉瘤夹闭术的一个重要组成部分，以避免术中出血。关于临时闭塞在脑血管痉挛发展中作用的信息很少。本研究的目的是在该领域提供更多信息。
我们对292例脑动脉瘤患者进行了手术。数据来自前瞻性收集的数据库，其中包括蛛网膜下腔出血的严重程度信息，以及经颅多普勒数据和手术数据，如临时闭塞情况。
在我们50%的患者中，手术期间进行了临时闭塞。29%的患者术后头颅CT显示有缺血性病变，其中58%的患者进行了临时闭塞（未进行临时闭塞的患者为47%，p = 0.09）。有梗死影像学征象的患者平均闭塞时间更长。此外，预后不良的患者临时闭塞时间更长。接受临时血管闭塞的患者中有34%术后发生血管痉挛（未进行临时闭塞的患者为20%，p < 0.006）。临时闭塞时间与经颅多普勒血流速度所定义的血管痉挛发展相关。接受临时闭塞治疗的患者中有48%患有大脑中动脉瘤（未进行临时闭塞的患者为22%，p < 0.0001）。该区域大多出现血流速度增加（p < 0.003）。
根据我们的结果，临时血管闭塞似乎有可能是动脉瘤性蛛网膜下腔出血后加重血管痉挛的一个额外因素。
