J Korean Neurosurg Soc.  2018 Nov;61(6):761-766. 10.3340/jkns.2017.0242.

Modified Arachnoid Plasty Reduces Chronic Subdural Hematoma after Unruptured Aneurysm Clipping : Technical Note

• Lee WJ
• Nam TM
• Jo KI
• Yeon JY
• Hong SC
• Kim JS

• KMID: 2428119
• DOI: http://doi.org/10.3340/jkns.2017.0242

Abstract

OBJECTIVE
Chronic subdural hematoma (CSDH) is a rare complication of unruptured intracranial aneurysm (UIA) clipping surgery. To prevent postoperative CSDH by reducing subdural fluid collection, we applied the modified arachnoid plasty (MAP) during the UIA clipping surgery to seal the dissected arachnoid plane.
METHODS
This retrospective study included 286 patients enrolled from July 2012 to May 2015. We performed arachnoid plasty in all patients, with MAP used after June 17, 2014. Patients were divided into two groups (non-MAP vs. MAP), and by using uni- and multivariate analyses, baseline characteristics, and relationships with postoperative CSDH between the two groups were analyzed. The degree of preoperative brain atrophy was estimated using the bicaudate ratio (BCR) index.
RESULTS
Ten patients (3.5%) among 286 patients had postoperative CSDH after clipping. Nine (3.1%) were in the non-MAP group, and one (0.9%) was in the MAP group. The higher BCR index showed statistical significance with occurrence of postoperative CSDH in both uni- (p=0.018) and multivariate (p=0.012; odds ratio [OR], 8.547; 95% confidence interval [CI], 1.616-45.455) analyses. MAP was associated with a lower risk of postoperative CSDH (p=0.022; OR, 0.068; 95% CI, 0.007-0.683).
CONCLUSION
This study shows that the degree of preoperative brain atrophy is associated with an increased occurrence of CSDH after clipping and that MAP could help reduce the risk of postoperative CSDH after unruptured aneurysm clipping via a lateral supraorbital approach.

Keyword

Unruptured aneurysm; Arachnoid plasty; Subdural fluid collection; Chronic subdural hematoma

MeSH Terms

Aneurysm*
Arachnoid*
Atrophy
Brain
Hematoma, Subdural, Chronic*
Humans
Intracranial Aneurysm
Multivariate Analysis
Odds Ratio
Retrospective Studies

Figure

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  Fig. 1. A : Illustration shows a feeding tube put into the opened Sylvian fissure after clipping. B : The opened arachnoid plane is covered with multiple absorbable hemostatic gelatin sponges. C : After the reinforcement of gelatin sponges covered surface using fibrin glue, we infuse normal saline through the feeding tube. D : The sunken brain was refloated, and the entrance hole of the tube was plugged with a gelatin sponge.

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  Fig. 2. A : Microscopic view showing surgically dissected arachnoid membrane and opened Sylvian fissure. B : Covered Sylvian fissure using multiple gelatin sponges and fibrin glue.

Reference

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