Balancing Time and Risk: Temporary Arterial Occlusion in Middle Cerebral Artery Aneurysm Surgery

Area of Science:

• Neurosurgery
• Vascular Neurology
• Cerebrovascular Disease

Background:

• Temporary arterial occlusion (TAO) is crucial for middle cerebral artery (MCA) aneurysm clipping.
• The safe duration of TAO and its impact on perioperative ischemia, especially in subarachnoid hemorrhage (SAH), require clarification.

Purpose of the Study:

• To evaluate the association between temporary arterial occlusion (TAO) duration and perioperative ischemia in patients undergoing microsurgical clipping of MCA aneurysms.
• To determine if rupture status (SAH vs. incidental) modifies the risk of ischemia associated with TAO.

Main Methods:

• Retrospective analysis of 245 patients with MCA aneurysms (2010-2020).
• Data collected included TAO use, duration, number of applications, occlusion site, and clinical/radiographic outcomes.
• Multivariable regression models were used to assess associations, adjusting for covariates.

Main Results:

• TAO was used in 54.7% of cases, with a mean duration of 10.4 minutes.
• Overall, TAO duration was not linked to ischemia or cerebral vasospasm (CVS).
• In SAH patients, cumulative TAO > 5 minutes significantly increased ischemia odds (OR 6.33, p=0.012), but not in incidental cases.

Conclusions:

• Judicious TAO is safe for incidental MCA aneurysms.
• Cumulative TAO exceeding 5 minutes significantly elevates ischemia risk in SAH patients.
• TAO management should be tailored to rupture status, neurological grade, and aneurysm morphology.