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Temporary Occlusion of Trunk Arteries of the Brain during Surgery

  • Jiro Suzuki

Abstract

Together with increases in the use of microsurgery in recent years, there have even been reports that temporary clipping of afferent and efferent vessels during radical operations on cerebral aneurysms is not required5, 15. It is, however, indisputable that the incidence of rupture during peracute surgery is high and in order to obtain improved results from such early period surgery, temporary clipping is mandatory. That is, during surgery an immediately following the rupture of a cerebral aneurysm, the aneurysm may well rupture again even if blood pressure is controlled. Even when attempts to place temporary clips on a hemorrhaging vessel are then made, secondary damage to the substance of the brain or other vessels can easily be brought about in the ensuing struggle to prevent massive bleeding. If, however, temporary clips had previously been placed on the afferent artery prior to dissection of the aneurysm, then safe and certain treatment of the aneurysm neck would have been possible. Moreover, it is worth noting that not a small percentage of aneurysm cases present problems of various kinds. If, for example, the neck region is not completely dissected and neck clipping or neck ligation is performed, a daughter aneurysm present on the posterior side of the aneurysm may go unnoticed, kinking of afferent or efferent arteries may be brought about, or a branch of the artery leaving the back of the aneurysm may be overlooked and clipping might be done on the neck and artery together. For this reason, we believe that, prior to the start of aneurysm dissection, it is better to bring the internal pressure of the aneurysm to zero using a temporary clip, to collapse the aneurysm, and then to perform a rapid and certain treatment of the neck region.

Keywords

Cerebral Aneurysm Vascular Occlusion Occlusion Time Temporary Occlusion Bilateral Occlusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Alexander E, Adams JE, Davis CH (1963) Complications in the use of temporary intracranial arterial clip. J Neurosurg 20: 810–811PubMedCrossRefGoogle Scholar
  2. 2.
    Botterell EH, Lougheed WM, Morley TP et al (1958) Hypothermia in the surgical treatment of ruptured intracranial aneurysms. J Neurosurg 15: 4–18PubMedCrossRefGoogle Scholar
  3. 3.
    Dujovny M, Osgood CP, Barrionuevo PJ et al (1978) SEM evaluation of endothelial damage following temporary middle cerebral artery occlusion in dogs. J Neurosurg 48: 42–48PubMedCrossRefGoogle Scholar
  4. 4.
    Lougheed WM, Sweet WH, White JC et al (1955) The use of hypothermia in surgical treatment of cerebral vascular lesions. A preliminary report. J Neurosurg 12: 240–255PubMedCrossRefGoogle Scholar
  5. 5.
    Michenfelder JD, Gronert GA, Rehder K (1982) Anesthesia. In: Youmans JR (ed) Neurological surgery, 2 edn. Saunders, Philadelphia, pp 1119–1135Google Scholar
  6. 6.
    Mizoi K, Yoshimoto T, Suzuki J (1981) Experimental study of new protective substances functional recovery of severe incomplete ischemic brain lesion, pretreated with mannital and perfluorochemicals. Acta Neurochir (Wien) 56: 157–166CrossRefGoogle Scholar
  7. 7.
    Pool JL (1961) Aneurysms of the anterior communicating artery. Bifrontal craniotomy and routine use of temporary clips. J Neurosurg 18: 98–111PubMedCrossRefGoogle Scholar
  8. 8.
    Sugita K, Hirota T, Iguchi I et al (1976) Comparative study of the pressure of various aneurysm clips. J Neurosurg 44: 723–727PubMedCrossRefGoogle Scholar
  9. 9.
    Suzuki J, Fujimoto S, Mizoi K et al (1984) The protective effect of combined administration of anti-oxidants and perfluorochemicals on cerebral ischemia. Stroke 15: 672–679PubMedCrossRefGoogle Scholar
  10. 10.
    Suzuki J, Komada N, Homma M (1979) New clip and flexible clip forceps for neurosurgery. In: Suzuki J (ed) Cerebral aneurysms. Neuron Pub, Tokyo, pp 386–388Google Scholar
  11. 11.
    Suzuki J, Kwak R, Okudaira Y (1979) The safe time limit of temporary clamping of cerebral arteries in the direct surgical treatment of intracranial aneurysm under moderate hypothermia. Tohoku J Exp Med 127: 1–7PubMedCrossRefGoogle Scholar
  12. 12.
    Suzuki J, Onuma T, Yoshimoto T (1979) Results of early operation on cerebral aneurysms. Surg Neurol 11: 407–412PubMedGoogle Scholar
  13. 13.
    Suzuki J, Tanaka S, Yoshimoto T (1981) Suppression of brain swelling with mannitol and perfluorochemicals an experimental study. Acta Neurochir (Wien) 58: 149–160CrossRefGoogle Scholar
  14. 14.
    Suzuki J, Yoshimoto T (1979) The effect of mannitol in prolongation of permissible occlusion time of cerebral arteries. Clinical date of aneurysm surgery. In: Suzuki J (ed) Cerebral aneurysms. Neuron Pub, Tokyo, pp 330–337Google Scholar
  15. 15.
    Yasargil MG, Fox JL (1975) The microsurgical approach to intracranial aneurysms. Surg Neurol 3: 7–14PubMedGoogle Scholar
  16. 16.
    Yoshimoto T, Sakamoto T, Watanabe T et al (1978) Experimental cerebral infarction. Part III: Protective effect of Mannitol in thalamic infarction in dogs. Stroke 9:217–218PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1987

Authors and Affiliations

  • Jiro Suzuki
    • 1
  1. 1.Division of Neurosurgery, Institute for Brain DiseasesTohoku University School of MedicineNagamachi, SendaiJapan

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