Use of temporary clipping in aneurysm surgery

Temporary clipping in aneurysm surgery has been used more frequently in recent years to increase the efficacy and safety of the neck dissection and obliteration. Experimental studies showed that neuroprotection using hypertension and mannitol administration diminishes the risk of ischaemia during this procedure. Recent studies show, however, that this method has to be used with caution. In a recent series of 85 aneurysms we used temporary vessel occlusion with neuroprotection described above in 17 patients (20 %), ranging from 2 to 35 minutes. The indication was peroperative rupture (3 cases), difficult neck dissection (13 cases) and a giant aneurysm (1 case). 14 of these patients had good results, one was severely disabled, the other 2 died. One of them had a large temporal haematoma and was HH V before the operation, the other one had a premature peroperative aneurysm rupture. The postoperative infarction rate was similar in the group of patients with temporary clipping (17 %) and without it (15 %). We conclude that temporary clipping in aneurysm surgery is a relatively safe procedure which facilitates the aneurysm neck dissection and enables neck obliteration in difficult cases. Better results are achieved with shorter duration of occlusion.