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Acta Neurochirurgica
Published in: Acta Neurochirurgica 6/2015

01-06-2015 | Clinical Article - Vascular

Results of re-exploration because of compromised distal blood flow after clipping unruptured intracranial aneurysms

Authors: Wonhyoung Park, Jae Sung Ahn, Sung Ho Lee, Jung Cheol Park, Byung Duk Kwun

Published in: Acta Neurochirurgica | Issue 6/2015

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Abstract

Background

One of the major causes for performing unplanned re-exploration of a craniotomy after microsurgery for unruptured intracranial aneurysms (UIAs) is compromised distal blood flow after clipping. Therefore, it is important to identify the causes of compromised distal blood flow after clipping and the factors that influence the prognosis for re-exploration in order to decrease ischemic complications related to clipping UIAs.

Method

Between January 2007 and December 2013, 1954 patients underwent microsurgery for UIAs. In this cohort, 20 patients (1.0 %) required unplanned re-exploration of the craniotomy for several reasons, and 11 patients (0.6 %) underwent unplanned re-exploration with clip repositioning or changing of the previous clip because of compromised distal blood flow after clipping. Patient characteristics, aneurysm properties, intraoperative findings, annual incidence and prognosis were analyzed in these 11 patients.

Results

The annual incidence of re-exploration has gradually decreased since the introduction of several intraoperative monitoring techniques. In total, 3.0 % of UIAs in the M1 trunk, 0.8 % of UIAs at the origin of the anterior choroidal artery (AchA) and 0.5 % of UIAs at the bifurcation of the middle cerebral artery (MCA) required re-exploration. Here, all 11 UIAs had broad necks, and atherosclerosis was identified around 10 UIAs. Six patients with compromised MCA flow demonstrated relatively better outcomes following re-exploration than five patients with a compromised lenticulostriate artery (LSA) or AchA flow. Four patients with delayed ischemic symptoms demonstrated relatively better outcomes than the seven patients who developed ischemic symptoms immediately postoperatively.

Conclusion

Clinicians need to be more careful not to compromise distal blood flow when clipping UIAs at the MCA and AchA origin. Various intraoperative monitoring techniques can help reduce the incidence of compromised distal blood flow after clipping.
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Metadata
Title
Results of re-exploration because of compromised distal blood flow after clipping unruptured intracranial aneurysms
Authors
Wonhyoung Park
Jae Sung Ahn
Sung Ho Lee
Jung Cheol Park
Byung Duk Kwun
Publication date
01-06-2015
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 6/2015
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-015-2408-6

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