Abstract
Temporary clipping of the major arterial trunk is a very important maneuver in controling excessive unexcepted bleeding and adequately exposing the aneurysm, and sometimes it is necessary to use it repeatedly. But we here experienced 5 cases in the past 5 years where neurological complications occurred secondarily to repeated temporary clippings. The duration of one temporary clipping time was 5 to 15 minutes, and clipping was repeated 3 to 5 times.
To confirm and explain these clinical experiences, three temporary clippings at 40 minute intervals of the MCA were performed on 20 cats using the O'Brien method. Pial arterial behavior and pathological changes of the brain were observed in ten non-treated and ten barbiturate-treated cats. In our experience, a single 20 minute clipping does not provoke any ischemic injury to the brain, and pial arterial caliber returns to the resting level within 40 minutes. But three 20 minute temporary clippings produced considerable ischemic injury and a dilated state of the pial artery in the cats with no treatment, although these changes were secondary to repeated temporary clippings in the cats with barbiturate treatment. From these experimental results, we concluded that even if the time is short, repeated temporary clippings may produce a higher incidence of ischemic brain damage, and if repeated temporary clippings are performed in aneurysmal surgery, brain protection with barbiturates should be conducted.
