Temporary Occlusion of Trunk Arteries of the Brain during Surgery

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 required^{5, 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.