Asian Journal of Neurosurgery

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 14  |  Issue : 3  |  Page : 773--779

Use of our protocol of multimodality tools to aid in the safe microsurgical clipping of unruptured anterior circulation aneurysms


Satish Kannan1, Yasuhiro Yamada2, Kyosuke Miyatani2, Takao Teranishi2, Arun Reddy Marathi3, Krishna Mohan4, Tsukasa Kawase2, Yoko Kato2 
1 Department of Neurosurgery, Institute of Neurosciences and Spinal Disorders, MGM Health Care, Chennai, Tamil Nadu, India
2 Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
3 Department of Neurosurgery, Prathima Hospitals, Hyderabad, Telangana, India
4 Department of Neurosurgery, KIMS, Nellore, Andhra Pradesh, India

Correspondence Address:
Satish Kannan
Institute of Neurosciences and Spinal Disorders, MGM Health Care, Chennai, Tamil Nadu
India

Objectives: The aim of this study is to analyze the effectiveness of our protocol of the use of multimodality tools, namely indocyanine green-dual image video angiography, neuroendoscope, neuromonitoring with motor-evoked potential, micro-Doppler in the microsurgical clipping of unruptured anterior circulation aneurysms, operated at our institute from January 2016 to December 2018. Materials and Methods: We performed a retrospective analysis of all cases of unruptured anterior circulation aneurysms, operated at Fujita Health University Banbuntane-Hotokukai Hospital, Japan, from January 2016 to December 2018. We assessed outcome at immediate postoperative, at discharge, and at 3 months follow-up by defining permanent morbidity as drop in Modified Rankin Scale (MRS) by 1 at 3 months follow-up and transient morbidity as temporary deficit that improved at discharge or follow-up. Postoperative events, namely seizures, infection that did not affect/change. Preoperative MRS and discharge timing were excluded. We concluded poor outcome as MRS ≥3 and good outcome as MRS <3 (0–2). All patients had a minimum of 3 months follow-up before outcome conclusion. Results: In 2016, a total of 98 cases were operated with no mortality or permanent morbidity (i.e., change in preoperative MRS), only transient morbidity was seen in (two cases) 2.04%. In 2017, a total of 119 cases were operated with no mortality or morbidity. In 2018, a total of 130 cases were operated with no mortality or permanent morbidity, only transient morbidity 0.7%. Summarizing from January 2016 to December 2018, a total of 347 cases of anterior circulation aneurysms were operated. Mostly, in the female sex (73.3%), the most common was middle cerebral artery aneurysm (39.1%). The mean size was 5.3 mm with no mortality or permanent morbidity with only transient morbidity in 0.9%. No poor outcome (MRS ≥3) was seen in our series. Conclusion: In our center for most unruptured anterior circulation aneurysms, microsurgical clipping is the treatment of choice. We believe our protocol of the intra-operative usage of multimodality tools have aided in the safe microsurgical clipping and have consistently resulted in good operative outcomes. Hence, we recommend and continue to use our Fujita-Bantane Protocol in all cases of micro-surgical clipping of aneurysms to consistently achieve good operative outcomes.


How to cite this article:
Kannan S, Yamada Y, Miyatani K, Teranishi T, Marathi AR, Mohan K, Kawase T, Kato Y. Use of our protocol of multimodality tools to aid in the safe microsurgical clipping of unruptured anterior circulation aneurysms.Asian J Neurosurg 2019;14:773-779


How to cite this URL:
Kannan S, Yamada Y, Miyatani K, Teranishi T, Marathi AR, Mohan K, Kawase T, Kato Y. Use of our protocol of multimodality tools to aid in the safe microsurgical clipping of unruptured anterior circulation aneurysms. Asian J Neurosurg [serial online] 2019 [cited 2019 Dec 9 ];14:773-779
Available from: http://www.asianjns.org/article.asp?issn=1793-5482;year=2019;volume=14;issue=3;spage=773;epage=779;aulast=Kannan;type=0