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Clinical Interrogation of Mandatory Insertion of Central Venous Catheter for Clipping Surgery of Unruptured Intracranial Aneurysm: A Propensity Score Matched Study

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Abstract
Background and Objective: Microsurgical clipping, along with endovascular treatment, has evolved in the treatment of unruptured intracranial aneurysms (UIA), and these developments have resulted in a reduction of the complication rate. We discuss the need for a central venous catheter (CVC) insertion as an anesthetic preparation for microsurgical clipping. Methods: Between January 2019 and September 2019, 722 patients with UIA were treated at our institution. We excluded patients with a history of endovascular treatment or bypass surgery, recurrent aneurysms after coil embolization, brain tumors, or subarachnoid hemorrhages. A total of 272 patients were enrolled. Eighty-four patients underwent CVC insertion, and 188 patients underwent clipping surgery without CVC insertion. Outcome-related factors were compared between the 2 groups. We performed propensity score matching of the 2 groups to increase comparability. Results: There were no significant differences in outcome, sex, aneurysm location, aneurysm multiplicity, aneurysm size, or comorbid disease between the 2 groups. The mean age at the time of surgery was higher in the non-CVC insertion group than in the CVC insertion group. There were no meaningful differences in primary outcomes, including premature rupture and intraoperative motor evoked potential/somatosensory evoked potential change, and secondary outcomes, including estimated blood loss, duration of intensive care unit stay, duration of hospitalization, and Glasgow Outcome Scale score at discharge. Conclusions: CVC insertion for clipping surgery for UIA is not mandatory. Considering the possible complications associated with CVCs, we cautiously suggest aneurysm surgery with CVC insertion in patients with serious medical comorbidities, aneurysm sizes >10 mm, and difficult proximal parent artery control.
Author(s)
윤별희변준호박용석김모이네이지성박원형박중철안재성
Issued Date
2021
Type
Article
Keyword
Central venous catheterClipping surgeryMicrosurgical clippingUnruptured intracranial aneurysm
DOI
10.1016/j.wneu.2020.10.106
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7630
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2465758956&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Clinical%20Interrogation%20of%20Mandatory%20Insertion%20of%20Central%20Venous%20Catheter%20for%20Clipping%20Surgery%20of%20Unruptured%20Intracranial%20Aneurysm:%20A%20Propensity%20Score%20Matched%20Study&offset=0&pcAvailability=true
Publisher
World Neurosurgery
Location
미국
Language
영어
ISSN
1878-8750
Citation Volume
146
Citation Number
1
Citation Start Page
e405
Citation End Page
e412
Appears in Collections:
Medicine > Medicine
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