Staggered or Continuous Temporary Clipping? – A Single-centre Chart Review
Arunkumar Sekar, Sujana Bollimuntha, Nandita Kujur, Sumit Bansal, Ashis Patnaik, Rabi Narayan Sahu
A
BSTRACT
Introduction:
Temporary clipping is standard practice in aneurysm surgery, yet the optimal duration and method (staggered vs. continuous) for its application remain uncertain, especially concerning neurological outcomes. This chart review investigates the relationship between the duration and type of temporary clipping and patient outcomes at a single center.
Methods:
This was a retrospective chart review of 85 patients who underwent micro neurosurgery for ruptured intracranial aneurysms with subarachnoid hemorrhage (SAH) between March 2022 and March 2024. Variables assessed included the type and duration of temporary clipping, and development of Delayed Ischemic Neurological Deficit (DIND).
Results:
The most common rupture site was ACOM (75%). Continuous temporary clipping was performed in 60% of cases and staggered temporary clipping in 40%. DIND was noted in 27 (31.7%) cases. Of the patients with DIND, 70% (19 patients) had undergone continuous temporary clipping, largely due to intraoperative rupture (IOR). All 8 patients with staggered clipping who developed DIND also had an IOR and a clipping time of more than 5 minutes. A statistically significant difference in DIND development between continuous and staggered clipping was only found when the duration was less than 5 minutes. IOR was found to be a major predictive factor for poor outcome.
Conclusion:
Intraoperative rupture is a predominant predictor of poor outcome. Elective staggered temporary clipping for less than 5 minutes under brain protective anesthesia is suggested to reduce the risk of IOR and and associated DIND. Continuous clipping is typically necessary as a rescue measure.