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Endoscope-assisted microsurgical clipping and reduction of post-clipping cerebral infarction: historical comparison using diffusion-weighted images

 Kang U Kim  ;  Jung-Jae Kim  ;  Keun Young Park  ;  Yong Bae Kim  ;  Hyun Jin Han 
 NEUROSURGICAL REVIEW, Vol.46(1) : 106, 2023-05 
Journal Title
Issue Date
Cerebral Infarction / etiology ; Cerebral Infarction / surgery ; Endoscopes ; Endoscopy ; Humans ; Intracranial Aneurysm* / etiology ; Intracranial Aneurysm* / surgery ; Neurosurgical Procedures* / methods ; Retrospective Studies ; Surgical Instruments ; Treatment Outcome
Endoscope ; Endoscope-assisted clipping ; Microscopic clipping ; Post-clipping infarction ; Unruptured intracranial aneurysms
Endoscopic assistance for aneurysm clipping and its possible benefits have been suggested in previous studies, but its clinical significance has not been fully elucidated. This study aimed to present the efficacy of endoscopy-assisted clipping in reducing post-clipping cerebral infarction (PCI) and clinical outcomes via a historical comparison of patients in our institution from January 2020 to March 2022. A total of 348 patients were included, 189 of whom underwent endoscope-assisted clipping. The overall incidence of PCI was 10.9% (n = 38); it was 15.7% (n = 25) before applying endoscopic assistance and decreased to 6.9% (n = 13) after endoscope application (p = 0.010). The application of a temporary clip (odds ratio [OR]: 2.673, 95% confidence interval [CI]: 1.291-5.536), history of hypertension (OR: 2.176, 95% CI: 0.897-5.279), history of diabetes mellitus (OR: 2.530, 95% CI: 1.079-5.932), and current smoker (OR: 3.553, 95% CI: 1.288-9.802) were independent risk factors of PCI, whereas endoscopic assistance was an independent inverse risk factor (OR: 0.387, 95% CI: 0.182-0.823). Compared to the location of the unruptured intracranial aneurysms, internal carotid artery aneurysms showed a significant decrease in the incidence of PCI (5.8% vs. 22.9%, p = 0.019). In terms of clinical outcomes, PCI was a significant risk factor for longer admission duration, intensive care unit stay, and poor clinical outcomes. However, endoscopic assistance itself was not a significant risk factor for clinical outcomes on the 45-day modified Rankin Scale. In this study, we noted the clinical significance of endoscope-assisted clipping in preventing PCI. These findings could reduce the incidence of PCI and improve the understanding of its mechanisms of action. However, a larger and longer-term study is required to evaluate the benefits of endoscopy on clinical outcomes.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0003-2262-7157
Kim, Jung-Jae(김정재) ORCID logo https://orcid.org/0000-0002-4669-8577
Park, Keun Young(박근영)
Han, Hyun Jin(한현진) ORCID logo https://orcid.org/0000-0002-4111-4819
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