Temporary vascular occlusion during aneurysm surgery

Premature rupture of a cerebral aneurysm during operation is a serious hazard. Direct pressure and suction may not always be effective in controlling the hemorrhage, and hasty dissection under such circumstances can cause serious injury to vital structures. In facing this risk, elective temporary arterial occlusion of parent vessels can be an advantage. Temporary clipping also may be helpful in the case of a giant aneurysm when the lesion must be opened and evacuated, or in the case of a thin-walled fundus tightly adherent to perforating vessels. Reduction of tension in the aneurysmal sac can be a valuable aid to safe dissection. The authors reviewed a total of 185 cases of intracranial aneurysm operated upon (L.S.) in the 5-year period between January 1980 and January 1985. Sixty-six patients (35.7%) underwent temporary arterial occlusion during the operations. Clinical outcome was excellent in 65.2% of the patients, good in 13.6%, fair in 12.1%, and poor in 3%. The mortality rate was 6.1%. No significant difference was found by comparing the 66 patients with temporary arterial occlusion with the 119 patients without occlusion. The longest occlusion time for the patients with excellent outcome was 23 minutes for bilateral A1 segments, 40 minutes for middle cerebral artery, 27 minutes 44 seconds for internal carotid artery, and 13 minutes 30 seconds for basilar artery. This study suggests that temporary arterial occlusion does not necessarily increase the overall mortality and morbidity in aneurysm surgery. When justified and used with caution it can be a valuable adjunct for the neurosurgeon.