Factors of Temporary Arterial Occlusion During Anterior Communicating Artery Aneurysm Repair

Characteristics*

Total number of patients

Sex

Male

6 (29)

Female

15 (71)

Male/female rate

0.4

Mean age (years)

52.8 ± 16.5

Range (years)

19–78

Presentation

Unruptured

9 (43)

Ruptured

12 (57)

Fisher grade

6 (50)

5 (42)

1 (8)

Glasgow Coma Scale

13–15

20 (95)

8–12

1 (5)

0 (0)

Comorbidities

Hypertension

16 (76)

Smoker

14 (66)

Alcohol

7 (33)

Obesity

8 (38)

Dyslipidemia

8 (38)

*Values represent number of patients, with percentages given in parentheses

Table 2

Summary of aneurysm morphological characteristics

Characteristics*
Aneurysm size
Small (<10 mm)	21 (100)
Large (10–25 mm)	0 (0)

*Values represent number of patients, with percentages given in parentheses

The surgical case characteristics and details regarding postoperative course were reviewed and are summarized in Table 3. The clinical outcome of the patients was assessed at 1-year follow-up by “Glasgow Outcome Scale – GOS”, as defined: GOS 5 – good recovery (resumption of normal life despite deficits); GOS 4 – moderate disability (disabled but independent); GOS 3 – severe disability (conscious but disabled); GOS 2 – persistent vegetative state; and GOS 1 – death.

Table 3

Summary of surgical case characteristics and post-operative course

Characteristics*
Intraoperative aneurysm rupture	3 (14)
Temporary clipping performed	21 (100)
Average clip duration	13.8 ± 6.4
Lamina terminalis opening	15 (71)
Complications
Vasospasm	14 (66)
Mild	10 (71)
Severe	4 (29)
Delayed ischemic deficit	6 (28)
Hydrocephalus	11 (52)
GOS 1-year follow-up
GOS 5	8 (38)
GOS 4	6 (28)
GOS 3	2 (9)
GOS 2	3 (14)
GOS 1	2 (9)

*Values represent number of patients, with percentages given in parentheses

Results

Aneurysms larger than 7 mm were more likely to be treated with longer temporary clipping time than small aneurysms, <7 mm (11.3 ± 4.1 vs. 22 ± 5.7, t-Test, p < 0.0001). There was no statistical correlation between time of occlusion and outcome (r = 0.92, Pearson, p > 0.08). There was also no statistical difference in outcome between patients submitted to intraoperative temporary clipping during more or less than 20 min.

Age, Glasgow Coma Scale (GCS) at initial evaluation, and Fisher scale at first CT scanning were independent factors of unfavorable outcome (Glasgow Outcome Scale ≤3) (cox-regression, p < 0.001). Among variable factors, being older than 50 years, an initial GCS under 13, and a Fisher grade III or IV resulted in worse outcome.

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