Judicious use of temporary clipping on atheromatous vessels and avoidance of its complications in aneurysm surgery: A single-centre experience

Abstract

Introduction: Since the invention of aneurysm clipping surgery, temporary clipping of proximal vessels has been an integral part of the surgery. Temporary clipping provides adequate control of the proximal vessel and allows the surgeon to clip the aneurysm more confidently. Whereas, its complications are numerous, and one has to be very conscious in applying temporary clips, especially over the atheromatous vessels. Methods: A cross-sectional observational study was conducted on 50 cases of intracranial aneurysms operated at the study centre, wherein temporary clipping is used, and atheromatous proximal vessels were seen and noted. intraoperatively. Post-operative complications in these cases were noted. Results: The atheromatous proximal vessel as identified intraoperatively was seen in 60% of the cases. The mean age of the study population was 55.86 years. About 32% of the study population were male. The average body mass index of the study population was 24.5. 72% of the study group were hypertensive and 44% were diabetic. About 48% of patients presented with the World Federation of Neurosurgical Societies Grade 2. About 88% of the aneurysms were in the anterior circulation, with a mean size of <7 mm, and mean neck size was 4.8 mm. The average frequency of usage of temporary in each case was 3.08 times, and the longest clip used was for 8 min. The complications encountered in post-operative period were multiple lacunar infarcts (12%), massive infarcts along the parent vessel (4%) and vasospasm (16%). Conclusion: Temporary clips are notorious for causing thromboembolism and strokes when applied on atheromatous vessels. One must be careful while applying it and try to use other methods like adenosine in facilitating aneurysm clipping.