Research Of Security Of The Use Of Temporary Atrerial Occlusion In Patients Undergoing Microsurgery For Cerebral Aneurysm

Background: Temporary arterial occlusion technique is very important inassistive technology during intracranial aneurysms clipping operation, but it isnot absolutely safe. According to reports, the incidence of cerebral vascularevents include delayed cerebral ischemia and cerebral infarction due totemporary occlusion of the aneurysm surgery is probability5.2%-19%[1],whichhad a serious impact on the patient’s prognosis. Many scholars tried to study thepostoperative clinical and radiographic changes to determine the period ofstroke-free temporary occlusion, but factors taking into account are not only theposition where aneurysms locate, also include many complicated factors[2]. Thispaper through the contrast between patients with preoperative andpostoperative ischemic symptoms and auxiliary examination changes, aretrospective analysis of intracranial aneurysm operation in patients with theclinical data of patients, gender, age, preoperative blood pressure and pulsepressure, preoperative grading of Hunt-Hess, improved Fisher classification,aneurysm location and so on, to find the safety period of clinical application indifferent vascular status, to provide a scientific basis for more safety oftemporary occlusion technology.Research method: Between2001January and2010November in ourhospital,463patients with aneurysmal subarachnoid hemorrhage (SAH) weretreated surgically. Temporary arterial occlusion was performed in152of thesepatients to facilitate dissection and permanent aneurysm repair. Gendercomposition for the male168, female295cases, aged14to82years, mean ageof50.54+/-10.53years. The anterior cerebral and anterior communicatingartery aneurysm in80cases, middle cerebral artery and its branches in29cases of intracranial aneurysm, carotid and internal carotid posterior communicatingartery aneurysms in43cases.By reviewing the relevant reports, postoperative ischemic events may berelated to the8factors including gender, age, preoperative grading ofHunt-Hess, improved Fisher classification, preoperative blood pressure andpulse pressure, aneurysm location, the period of occlusion, the way ofocclusion，for the convenience of operation, the number of the above factors,see table1. All data using SAS statistical software for logistic single factor andmultivariate stepwise regression analysis，P <0.05were statistically significant.And then use SPSS17.0software to draw the ROC curve for screening out thefactors in order to find the cutoff blocking cerebrovascular events occurred indifferent states.Results: The incidence of postoperative aneurysm temporary occlusionrelated to cerebrovascular events in25patients, the incidence rate of16.45%.Single factor analysis of data obtained by the Logistic, age、pulse pressuredifference, improved Fisher classification, the period of occlusion，the way ofocclusion are high risk factors to the occurrence of cerebral vascular events.Further line multi-factor analysis to come to the age, pulse pressure, the periodof occlusion are major factors in the occurrence of cerebral vascular events.Age, pulse pressure, the period of occlusion to draw the ROC curve analysisobtained under different conditions blocking the cut-off value of the relatedcerebral vascular events.Research conclusions: Through single factor analysis and muti-factoranalysis，our research convinced that：age、pulse pressure difference, improvedFisher classification, the period of occlusion，the way of occlusion are highrisk factors to the occurrence of cerebral vascular events，age, pulse pressure,the period of occlusion are major factors in the occurrence of cerebral vascularevents. This research made a detailed study through drawing ROC curves of the time limit in different cerebral artery with temporary occlusion，providesdetailed data for the future more secure temporary blocking to support. And inthis study, intermittent basis cause cerebral vascular event after the incidence ofblocking a significantly higher than last, and most of the research results beforeabhorrent, its reason needs to be further explored. But along with theimprovement of science and technology, intraoperative monitoring technologyto considerable development, providing a more intuitive performer for the exactguarantee, gradually become neurosurgery doctor intraoperative temporaryblocking technology application of the "third eye", needs to be further researchand development.