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Updated: May 10, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Rapid ventricular pacing in cerebral aneurysm clipping: institutional workflow, systematic review, and single-arm
Johannes Wach1, Martin Vychopen2, Ferdinand Weber2
1Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. johannes.wach@medizin.uni-leipzig.de.
Insights
Rapid ventricular pacing (RVP) for cerebral aneurysm clipping is safe and effective, showing low risks of arrhythmia and myocardial injury. This technique achieves high rates of aneurysm obliteration with minimal impact on neurological outcomes and mortality.
Area of Science:
- Neurosurgery
- Cardiology
- Medical Technology
Background:
- Cerebral aneurysms pose significant risks, necessitating effective surgical interventions.
- Cerebral aneurysm clipping is a common surgical procedure.
- Rapid ventricular pacing (RVP) is explored as an adjunct in neurosurgery.
Purpose of the Study:
- To evaluate the safety and efficacy of RVP in cerebral aneurysm clipping.
- To assess outcomes including arrhythmia, mortality, aneurysm obliteration, and neurological deficits.
- To investigate myocardial damage using postoperative troponin T levels.
Main Methods:
- Systematic review and meta-analysis of institutional data and published studies.
- Analysis of outcomes: arrhythmia, mortality, aneurysm obliteration, mean arterial pressure (MAP), pacing parameters, and troponin T.
- Pooled event rates calculated using a common effect model; heterogeneity assessed with I² statistics.
Main Results:
- RVP-assisted clipping in 15 cases showed stable neurological outcomes, no cardiac complications, and 94% obliteration.
- Pooled data (141 patients) revealed 1% arrhythmia and 0% mortality rates.
- Overall obliteration was 92%, new neurological deficits 4%, and mean troponin T 37.7 ng/L.
Conclusions:
- RVP in cerebral aneurysm clipping is associated with low cardiac risks (arrhythmia, myocardial injury).
- The technique facilitates high rates of complete aneurysm obliteration.
- RVP appears safe with minimal impact on postoperative mortality and neurological outcomes.
Background:
This study examines the safety and efficacy of rapid ventricular pacing for cerebral aneurysm clipping, focusing on arrhythmia, mortality, aneurysm obliteration, neurological deficits, and myocardial damage assessed via postoperative troponin T levels, through an institutional series, systematic review, and meta-analysis.
Methods:
Data were extracted from institutional database and published studies investigating the use of RVP in both ruptured and unruptured aneurysms. Outcomes analyzed included postoperative arrhythmia, mortality, complete obliteration of aneurysms, pacing cycles, mean arterial pressure (MAP) during pacing, pacing rates, and postoperative troponin T levels. Pooled event rates and proportions were calculated using a common effect model, and heterogeneity across studies was assessed using I² statistics.
Results:
In 15 institutional cases, RVP-assisted aneurysm clipping achieved stable neurological outcomes, no cardiac complications, and 94% aneurysm obliteration. Combined with literature (141 patients), pooled arrhythmia and mortality rates were 1% and 0%, respectively. Aneurysm obliteration was 92%, new neurological deficits 4%, and troponin T levels 37.7 ng/L. Mean pacing rate, cycles, and MAP were 187.4 bpm, 6.5, and 41.1 mmHg.
Conclusion:
The findings suggest that rapid ventricular pacing in cerebral aneurysm clipping is associated with a low risk of cardiac arrhythmia and myocardial injury, while facilitating high rates of complete aneurysm obliteration. This technique appears safe, with minimal impact on postoperative mortality and neurological outcomes.
