[Intracranial definitive aneurysm surgery under normothermia and normotension--utilizing temporary occlusion of major cerebral arteries and preoperative mannitol administration (author's transl)]

Abstract

The permissible occlusion time of brain arteries and surgical results were discussed, based on 181 aneurysm cases, which received definitive aneurysm surgery by utilizing temporary clipping of brain arteries, preoperative mannitol administration and under normothermic, normotensive condition. 1) In order to analyze the influence of artery occlusion under mannitol administration, the causes of sequelae and deaths were examined together with the follow up studies which were taken from 6 months to 6 years and 4 months postoperatively in all cases. Of the total 181 cases, there were 16 cases with sequelae and 7 deaths. These causes were attributable to non-artery occlusion factors, such as postoperative vasospasm, surgical complications or infections, excepting in 3 cases or 1.7% in which possible effect of temporary occlusion cannot be completely ruled out. 2) The maximum occlusion times of each artery without suquelae were 80, 61, 50 and 30 minutes, respectively for the unilateral A1 portion, bilateral A1 portions (simultaneously occluded), intracranial internal carotid artery and M1 portion. 3) Surgical results at discharge showed a mortality rate of 3.8% and a morbidity rate of 7.0%. On follow up studies, taken from 6 months to 6 years and 4 months, more than 79% of the total 181 cases which received aneurysm surgery utilizing temporary occlusions, were reported in good health and working.