Background Currently, there is no data available regarding the temporary occlusion time tolerance of cerebellar vessels during surgery. We seek to ascertain original data on temporary occlusion of cerebellar vessels and identify factors that would decrease morbidity of procedures that require temporary clipping.
Methods A prospective 7-year study for awake surgery for complex aneurysms and vascular malformations was conducted - 202 patients; 162 (80%) patients Awake Craniotomy (AW), 40 (20%) under General Anesthesia (GA). In the awake cohort, 25 patients needed temporary occlusion of at least one of the 3 cerebellar main vessels as part of the microsurgical treatment (PICA: 16, AICA: 3, SCA:6). In addition to clinical neurological awake testing, standard controlled neurophysiological testing was performed. This study paradigm is based on standard immediate removal of temporary clip if any changes in awake or electrophysiological testing is detected.
Results Of the 16 patients who underwent temporary PICA occlusion, 7 tolerated occlusion (2-25 minutes), without any awake neurological findings. 9 developed Reversible Neurological Deficits (RND). Of the 3 patients who underwent AICA, none tolerated occlusion. All 3 developed neurological deficits (10 seconds -2 mins). Of the 6 who underwent SCA, 2 tolerated occlusion (1-18 minutes), without developing neurological deficits. 4 patients developed RND. Mean time to develop RND was 55s (10-190s). No patient developed permanent neurological deficit from temporary occlusion testing in this study. Of the 16 patients who developed RND (in the cerebellar cohort), only 3 also had a concomitant change in motor evoked potentials. No patient developed EEG or SSEPs changes.
Conclusion This novel data suggests that certain cerebellar vessels may tolerate lengthy occlusion without permanent neurological deficits. Vessels that do not tolerate temporary occlusion result in neurological deficits within 190 seconds. Electrophysiological testing failed to detect ischemic changes in the majority of the subjects.
Disclosures Y. Al-Inaya: None. J. Wellington: None. J. Dhaliwal: None. N. Lehman: None. C. Spezzani: None. K. Paposhvili: None. A. Zidaru: None. N. Fernanda Borjas Calderón: None. M. Martinek: None. M. Bone: None. F. Amiri: None. N. Abdeljabbar: None. J. Watson: None. S. Abdulrauf: None.
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