Does a routine operation for intracranial aneurysm incur brain damage?

Abstract

A biochemical marker of brain cell damage, the BB-isozyme of the intracellular enzyme Creatine Kinase (CK), was used to evaluate any possible injury to the brain, caused by an operation for a ruptured intracranial aneurysm (SAH). CSF-CK BB was assessed before and at intervals after operation in a series of 60 patients, aged 29-71 (mean 51 years) operated on for intracranial aneurysms, all but one after SAH. The m/f ratio was 18/42. 35 of the 60 patients were operated on acutely, i.e. within 72 hours after the SAH. CK BB was determined as CKB-activity after immunological inactivation of CKM. Normally there should be almost no detectable enzyme activity in the CSF. The pre-operative CK BB-activity was 0.01+ -0.01 mikrokatal in the patients in Hunt & Hess grade I who were operated on > 7 days after their SAH, and 0.05+ -0.04 in those operated on acutely, probably still reflecting the effects of the SAH on the brain. The mean per-operative CK BB increase was 0.11+ -0.17 for patients who had an uneventful postoperative course, compared to 0.39+ -0.49 for those showing some degree of immediate postoperative deterioration. This difference is significant at the 1% level. 52 of the 60 patients showed a rise of CK BB after operation. The mean increase for those patients operated upon in a good state and without any complication or postoperative deterioration was 0.02+ -0.03 mikrokatal, which could therefore be considered as a "normal" or acceptable elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic factors for cerebral infraction and outcome in patients with intracranial aneurysm

“…Some authors have suggested that craniotomy results in the exacerbation of vasospasm, and that contributing factors include the release of blood and its products into the subarachnoid space, arachidonic acid and free radical liberation and the spastic response of brain arteries to surgical manipulation . In addition, dissection and disruption of brain parenchyma result in the release of lipid peroxides as arachidonic acid, which leads to the synthesis of prostaglandins and free radicals . The release of blood and its products associated with vessel manipulation during craniotomy, microsurgery and clipping is the likely responsible mechanism.…”