Yu Yamamoto1, Hitoshi Fukuda2, Daisuke Yamada1, Yoshitaka Kurosaki1, Akira Handa3, Benjamin Lo4, Sen Yamagata1. 1. Department of Neurosurgery, Kurashiki Central Hospital, Miwa, Kurashiki, Okayama, Japan. 2. Department of Neurosurgery, Kurashiki Central Hospital, Miwa, Kurashiki, Okayama, Japan. Electronic address: fukudaharpseal@gmail.com. 3. Department of Interventional Neuroradiology, Kurashiki Central Hospital, Miwa, Kurashiki, Okayama, Japan. 4. Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Rue University, Montreal, Quebec, Canada.
Abstract
BACKGROUND: Perforator infarction is a procedure-related complication of surgical clipping of ruptured anterior communicating artery (ACoA) aneurysms. Patients with perforator infarction may present with specific clinical features. The aim of this study was to elucidate incidence, risk factors, clinical course, and outcomes of perforator infarction following surgical clipping of ruptured ACoA aneurysms. METHODS: Retrospective analysis was performed of 104 patients from a single-center, observational cohort database who underwent surgical clipping for ruptured ACoA aneurysm. Risk factors of perforator infarction were identified. Correlation of perforator infarction with clinical course during hospitalization was investigated, focusing on dysfunction of hypothalamus and cerebral limbic system. We also evaluated any associations between perforator infarction and poor outcomes. RESULTS: Perforator infarction was observed in 24 (23.1%) patients. Use of temporary clip (P = 0.019, χ2 test) and intraoperative rupture (P < 0.001, χ2 test) were significantly associated with perforator infarction. Patients with perforator infarction had increased likelihood of hyponatremia (odds ratio 6.41 [95% confidence interval 2.27-18.1], P < 0.001) and insufficient oral intake (odds ratio 6.53 [95% confidence interval 1.80-23.7], P = 0.004) in the subacute stage of subarachnoid hemorrhage by multivariate analyses. Perforator infarction was an independent risk factor of poor functional outcomes at 3 months (modified Rankin Scale score 3-6; odds ratio 5.29 [95% confidence interval 1.62-17.2], P = 0.006). CONCLUSIONS: Perforator infarction following surgical clipping of ruptured ACoA aneurysms caused region-specific complications, including hyponatremia and insufficient oral intake, and was associated with poor functional outcomes.
BACKGROUND: Perforator infarction is a procedure-related complication of surgical clipping of ruptured anterior communicating artery (ACoA) aneurysms. Patients with perforator infarction may present with specific clinical features. The aim of this study was to elucidate incidence, risk factors, clinical course, and outcomes of perforator infarction following surgical clipping of ruptured ACoA aneurysms. METHODS: Retrospective analysis was performed of 104 patients from a single-center, observational cohort database who underwent surgical clipping for ruptured ACoA aneurysm. Risk factors of perforator infarction were identified. Correlation of perforator infarction with clinical course during hospitalization was investigated, focusing on dysfunction of hypothalamus and cerebral limbic system. We also evaluated any associations between perforator infarction and poor outcomes. RESULTS: Perforator infarction was observed in 24 (23.1%) patients. Use of temporary clip (P = 0.019, χ2 test) and intraoperative rupture (P < 0.001, χ2 test) were significantly associated with perforator infarction. Patients with perforator infarction had increased likelihood of hyponatremia (odds ratio 6.41 [95% confidence interval 2.27-18.1], P < 0.001) and insufficient oral intake (odds ratio 6.53 [95% confidence interval 1.80-23.7], P = 0.004) in the subacute stage of subarachnoid hemorrhage by multivariate analyses. Perforator infarction was an independent risk factor of poor functional outcomes at 3 months (modified Rankin Scale score 3-6; odds ratio 5.29 [95% confidence interval 1.62-17.2], P = 0.006). CONCLUSIONS: Perforator infarction following surgical clipping of ruptured ACoA aneurysms caused region-specific complications, including hyponatremia and insufficient oral intake, and was associated with poor functional outcomes.
Authors: William R Muirhead; Patrick J Grover; Ahmed K Toma; Danail Stoyanov; Hani J Marcus; Mary Murphy Journal: Neurosurg Rev Date: 2020-06-16 Impact factor: 3.042