Effect of Pharmacological Neuroprotection During Surgical Clipping of Anterior Circulation Intracranial Aneurysm on Neurological Outcome—A Randomized Controlled Study

OBJECTIVE: Patients with intracranial aneurysms while undergoing neurosurgical clipping frequently require the use of temporary clip, and this involves the risk of cerebral ischemia. The usual approaches for prevention of such an adverse event include use of pharmacological neuroprotection before temporary clipping of the parent vessel to induce burst suppression of EEG, or detecting ischemia using somatosensory-evoked potential (SSEP) of the relevant arterial territorial distribution and taking corrective measures. We studied the effect of preemptive pharmacological neuroprotection on postoperative neurological deficit and outcome in patients undergoing anterior circulation intracranial aneurysm surgery. METHODS: Prospective, randomized, comparative study included adult patients requiring temporary parent vessel occlusion during surgical clipping of ruptured intracranial aneurysm of the anterior circulation. Patients were randomized to Group N (pharmacological neuroprotection) or Group I (non-pharmacological neuroprotection). Anesthesia induction, maintenance of anesthesia, and extubation were standardized in both the groups. Cerebral ischemia monitoring was conducted in both groups using SSEP. Group N (n = 15): received pharmacological neuroprotection using propofol bolus; Group I (n = 15): SSEP monitoring and alerting the surgeon to ischemia, and taking appropriate corrective measures. RESULTS: The demographic data were comparable between the two groups. There was no statistically significant difference in new onset neurological deficit within 24 hrs between the groups (P = 0.64). There was no significant difference in neurological outcome measured by the extended Glasgow Outcome Scale (GOSE), between the groups at three and six months. CONCLUSION: This study shows no difference in short- or long-term neurological outcome with preemptive anesthetic neuroprotection during temporary arterial occlusion in anterior circulation intracranial aneurysm surgery. This pilot study was performed to estimate event rates and feasibility rather than to test efficacy.