Adenosine in facilitating aneurysm clipping: An institutional experience

Abstract

Introduction: Intracranial aneurysms are the one of most complicated conditions confronted by a neurosurgeon. Even though endovascular procedure is preferred, open surgery and clipping of the aneurysm still remains gold standard procedure for many aneurysms. Proximal control of the parent vessel remains one of the most critical steps in clipping the aneurysms and this can be achieved by various ways such as temporary clipping and transient cardiac standstill using adenosine. Temporary clipping is associated with complications such as infarct and injury to the vessel, whereas temporary hypotension using adenosine provides a way for successful clipping of the aneurysm. Here, we present our experience with adenosine in patients undergoing clipping of aneurysms in our institution between 2017 and 2020. Methodology: It is a retrospective cohort study conducted on patients undergoing craniotomy and clipping of aneurysms and in those where adenosine is not contraindicated. Patients are divided into Group A where adenosine is not used and Group B where adenosine is used. Results: In Group B, where adenosine is used, clipping was easier, with less incidence of intraoperative ruptures, less usage of Temporary clip (TC) and less incidence of infarct, reduce clipping time with no side effects. Conclusion: Adenosine-induced transient cardiac arrest and hypotension are a safe and effective method in facilitating aneurysm clipping.