caa a22 4500 606213686 CHVBK 20210128101048.0 cr unu---uuuuu 210128e20150601xx s 000 0 eng 10.1007/s00701-015-2408-6 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2408-6 Results of re-exploration because of compromised distal blood flow after clipping unruptured intracranial aneurysms [Elektronische Daten] [Wonhyoung Park, Jae Ahn, Sung Lee, Jung Park, Byung Kwun] Background: One of the major causes for performing unplanned re-exploration of a craniotomy after microsurgery for unruptured intracranial aneurysms (UIAs) is compromised distal blood flow after clipping. Therefore, it is important to identify the causes of compromised distal blood flow after clipping and the factors that influence the prognosis for re-exploration in order to decrease ischemic complications related to clipping UIAs. Method: Between January 2007 and December 2013, 1954 patients underwent microsurgery for UIAs. In this cohort, 20 patients (1.0%) required unplanned re-exploration of the craniotomy for several reasons, and 11 patients (0.6%) underwent unplanned re-exploration with clip repositioning or changing of the previous clip because of compromised distal blood flow after clipping. Patient characteristics, aneurysm properties, intraoperative findings, annual incidence and prognosis were analyzed in these 11 patients. Results: The annual incidence of re-exploration has gradually decreased since the introduction of several intraoperative monitoring techniques. In total, 3.0% of UIAs in the M1 trunk, 0.8% of UIAs at the origin of the anterior choroidal artery (AchA) and 0.5% of UIAs at the bifurcation of the middle cerebral artery (MCA) required re-exploration. Here, all 11 UIAs had broad necks, and atherosclerosis was identified around 10 UIAs. Six patients with compromised MCA flow demonstrated relatively better outcomes following re-exploration than five patients with a compromised lenticulostriate artery (LSA) or AchA flow. Four patients with delayed ischemic symptoms demonstrated relatively better outcomes than the seven patients who developed ischemic symptoms immediately postoperatively. Conclusion: Clinicians need to be more careful not to compromise distal blood flow when clipping UIAs at the MCA and AchA origin. Various intraoperative monitoring techniques can help reduce the incidence of compromised distal blood flow after clipping. Springer-Verlag Wien, 2015 Clip nationallicence Intracranial aneurysm nationallicence Ischemia nationallicence Microsurgery nationallicence Reoperation nationallicence Park Wonhyoung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut Ahn Jae Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut Lee Sung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut Park Jung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut Kwun Byung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut Acta Neurochirurgica Springer Vienna 157/6(2015-06-01), 1015-1024 0001-6268 157:6<1015 2015 157 701 https://doi.org/10.1007/s00701-015-2408-6 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2408-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Park Wonhyoung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut NATIONALLICENCE 700 1- Ahn Jae Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut NATIONALLICENCE 700 1- Lee Sung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut NATIONALLICENCE 700 1- Park Jung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut NATIONALLICENCE 700 1- Kwun Byung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736 l, Songpa-gu, Seoul, South Korea aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/6(2015-06-01), 1015-1024 0001-6268 157:6<1015 2015 157 701