부산대학교 도서관

OBJECTIVE: To review the result of microsurgical treatment for cerebral aneurysms at Princess Margaret Hospital, Hong Kong, SAR, with the focus on the use of elective temporary clipping (ETC) in reducing intraoperative aneurysm rupture (IOR). METHODS: All clinical notes and operation records of patients who had undergone aneurysm-clipping microsurgery from July 1996 to November 2002 were reviewed. RESULTS: In the past 6 years, 148 patients with 150 aneurysms had undergone microsurgical clipping operations. The overall usage rate of ETC was only 25% (38 out of 150) in the present surgical series. Elective temporary clipping was most frequently applied (40%) in treating anterior communicating artery aneurysm. The overall IOR rate was 26% without ETC, versus 8% with ETC, with 18% absolute risk reduction (95% confident interval: 3.2%−28.2%) and 70% relative risk reduction, respectively. The numbers needed for treatment was 5.55. The benefit of ETC was most prominently observed in treating anterior communicating artery aneurysm in which the IOR rate was reduced from 42 to 12%, with 30% absolute risk reduction. Among cases of IOR that occurred without prior elective temporary clip application, the mortality rate was 20.7%. For IOR patients with prior elective temporary clip application, there was no mortality. CONCLUSION: The present study demonstrates that ETC had led to a significant overall reduction in IOR rate and ETC was associated with better clinical outcome. We encourage and recommend the use of ETC in preventing IOR during aneurysm microsurgery. A prospective study will be conducted on the same topic in our hospitals.