抄録
A study was made on the usefulness and problematic points of temporary clipping and on premature rupture during surgery.
Direct aneurysm operation was performed on 232 of the 393 patients with ruptured intracranial aneurysms. Of these cases, a temporary clip was applied in 129 cases (56%), designated as group A in this study, but not in 103 cases (44%), designated as group B. An analysis was made on the difference between groups A and B with regard to age, preoperative computed tomography (CT) findings, site of ruptured aneurysms and Glasgow Outcome Scale six months after surgery. In addition, study was done on the rate of premature rupture by timing of surgery, by preoperative Hunt & Hess Grade, by site of ruptured aneurysms and by Glasgow Outcome Scale six months after surgery.
The proportion occupied by elderly patients more than 60 years of age was 43% in group A and 63% in group B; that is, the rate in which a temporary clip was applied was lower in elderly patients (p<0.01). As for site of ruptured aneurysms, a tendency was observed for the frequency of use of temporary clip to be high for anterior communicating artery aneurysms (p<0.01). However, no significant difference could be found between groups A and B in the preoperative CT and surgical results.
Of the 232 cases operated on, premature rupture occurred in 9 (4%) and a temporary clip was applied in all these cases of premature rupture. As for timing of surgery, a tendency was observed for premature rupture to occur during early operation performed within day 3. No significant difference could be found between premature rupture and preoperative grade. Analysis of the rate of premature rupture by site of ruptured aneurysms showed 3 (14%) out of 21 cases of internal carotid artery aneurysm, 5(8%) out of 63 cases of anterior communicating artery aneurysm, and 1(3%) out of 35 cases of middle cerebral artery aneurysm. Prognosis six months after surgery was somewhat unsatisfactory in the group with premature rupture during surgery. However, as the number of cases in this group was very small, the effect of premature rupture on prognosis could not be determined accurately. In patients in whom there is a possibility of premature rupture during surgery, it may be advisable to prevent such premature rupture by temporary clipping of the parent artery.
