Effect of Temporary Clipping on the Cerebral Infarction in Middle Cerebral Artery Aneurysm Surgery

Choi, Jeong Wook; Kim, Tae Sun; Joo, Sung Pil; Lee, Jung Kil; Kim, Jae Hyoo; Kim, Soo Han

Abstract

OBJECTIVE
This study evaluated the effects of temporary clipping on an infarction after middle cerebral artery aneurysmal surgery.
METHODS
Three hundreds and seventeen patients with a middle cerebral artery aneurysm were treated surgically at our department. Among them, the patients who had an intracerebral hematoma or a cerebral infarction prior to surgery or poor clinical mental state (Hunt and Hess grade V) on admission were excluded from the analysis. Two hundreds and twenty nine patients were selected in this study. An acute cerebral infarction, which had no any evidence of retraction injury or vasospasm and occurred on the same side of the surgical site within 3 days after the operation, was regarded as the cerebral infarction as a result of the temporary clipping.
RESULTS
Twenty out of 229 patients (8.7%) developed a new acute cerebral infarction after surgery. The causes of the infarction were as follows: 13 patients related to the temporary clipping, 5 patients to the vasospasm and 2 patients to the brain retraction injury. The incidence of an acute cerebral infarction according to the frequency of temporary clippings was 5.5% (3 of 55 patients) of those who underwent a single temporary clipping, 6.7% (4 of 60 patients) of those who underwent two or three temporary clipping and 20.7% (6 of 29 patients) of those who underwent more than 4 temporary clippings. The incidence of an acute cerebral infarction was significantly higher when the temporary clip had been applied more than 4 times (P<0.021). However, the clipping time didn't show statistically significance.
CONCLUSION
The incidence of acute cerebral infarction after a surgery for a middle cerebral artery aneurysm was related to the frequency of temporary clippings during surgery. It was significantly higher in the cases where more than 4 temporary clipping had been applied.