108630

Authors

• Shun Suzuki, Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
• Hidetoshi Ooigawa, Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan; Department of Neurosurgery, Tokorozawa Mihara General Hospital, Tokorozawa-shi, Saitama, Japan. Electronic address: h-oigawa@tmgh.jp.
• Kaima Suzuki, Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
• Hiroki Sato, Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.Follow
• Junichi Takeda, Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
• Milan Lepic, Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
• Hiroki Kurita, Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.

Document Type

Article

Abstract

BACKGROUND: This study aimed to clarify the risk factors for postoperative cerebral infarction in surgical clipping for prevalent small middle cerebral artery aneurysms (MCA Ans). METHODS: This retrospective study included 246 patients (mean age, 64.8 ± 10.0 years; 25.6 % males, 74.4 % females) with 258 aneurysms (mean aneurysm size, 5.4 ± 2.4 mm) who underwent direct surgery for unruptured MCA Ans at our institution from January 2015 to December 2020. All surgeries were performed under general anesthesia, incorporating indocyanine green videoangiography and transcranial motor-evoked potentials to enhance surgical precision and safety. The occurrence of surgery-related cerebral infarction was evaluated using postoperative CT scans within one week, comparing them with preoperative images. Patients were categorized based on the presence or absence of postoperative stroke and were analyzed for age, sex, past medical history, aneurysm size, number of clips used, and distance from the midline to the aneurysm. RESULTS: Seventeen patients had postoperative cerebral infarction (6.6 %, symptomatic 6, asymptomatic 11). There were no significant differences in terms of age, number of clips, or aneurysm size between the two groups; however, the distance from the midline to the aneurysm was significantly shorter in the stroke group (27.1 ± 4.7 mm; p < 0.001), with a cutoff value of 29 mm using the receiver operating characteristic curve. CONCLUSION: Surgical clipping for MCA Ans presents a high risk of cerebral infarction for aneurysms located closer to the midline, emphasizing the importance of considering aneurysm location as a risk indication in surgical clipping.

Keywords

Cerebral infarction, Clipping, Unruptured middle cerebral aneurysms

Medical Subject Headings

Humans; Female; Male; Middle Aged; Intracranial Aneurysm (surgery, diagnostic imaging); Aged; Retrospective Studies; Postoperative Complications (epidemiology, etiology); Neurosurgical Procedures (methods); Middle Cerebral Artery (surgery, diagnostic imaging); Brain Ischemia (etiology, diagnostic imaging); Risk Factors; Surgical Instruments; Cerebral Infarction (etiology, diagnostic imaging, epidemiology)

Publication Date

12-1-2024

Publication Title

Clinical neurology and neurosurgery

E-ISSN

1872-6968

Volume

247

PubMed ID

39531958

Digital Object Identifier (DOI)

10.1016/j.clineuro.2024.108630

Recommended Citation

Suzuki, Shun; Ooigawa, Hidetoshi; Suzuki, Kaima; Sato, Hiroki; Takeda, Junichi; Lepic, Milan; and Kurita, Hiroki, "108630" (2024). Translational Neuroscience. 2600.
https://scholar.barrowneuro.org/neurobiology/2600