A clinical study on the value of carotid cistern drainage during intracranial aneurysm clipping

Abstract

Introduction: To investigate the value of carotid cistern drainage in patients with aneurysmal subarachnoid haemorrhage during intracranial aneurysm clipping. Material and methods: Patients with ruptured intracranial aneurysms were included in this study. During the operation, the craniotomy was performed via a pterional approach to separate the Sylvian cistern and carotid cistern. After completing the clipping of the intracranial aneurysm, a drainage tube was placed in the carotid cistern between the ipsilateral internal carotid artery and optic nerve or lateral internal carotid artery, which was led out through the dura mater, cranial flap foramen or gap and scalp, and connected with an external drainage device. Results: A total of 6 patients with aneurysmal subarachnoid haemorrhage, who required craniotomy for clipping, were enrolled in the study. These patients were given carotid cistern drainage during the operation. Among these 6 patients, 2 had anterior communicating aneurysms, 1 had a posterior communicating aneurysm of the internal carotid artery, 2 had middle cerebral artery furcation aneurysms, and 1 patient had multiple intracranial aneurysms. For the Hunt-Hess score before the operation, 5 patients were in grade II and 1 patient was in grade III. Furthermore, the postoperative drainage was unobstructed, with a daily drainage of 130-290 ml of haemorrhagic cerebrospinal fluid (CSF). Conclusions: The CSF drainage of the carotid cistern applied in patients with aneurysmal subarachnoid haemorrhage during the craniotomy for clipping can effectively remove the subarachnoid haemorrhage, control the intracranial hypertension, and reduce the incidence of cerebral vasospasm and hydrocephalus.

Intraarterial nimodipine may not prevent cerebral ischaemia due to refractory vasospasm following aneurysmal subarachnoid haemorrhage

“…Nevertheless, we decided to use statin due to the lack of safety concerns presented in the aforementioned trial. In patients with aSAH undergoing clipping of the aneurysm through craniotomy, drainage of cerebrospinal fluid from the carotid cistern may remove the subarachnoid blood and reduce the risk of VS [ 10 ]; however, in our patient percutaneous intravascular embolization was performed. Intraarterial administration of vasodilators may be used when standard medical therapy is not effective [ 2 ].…”