Efficacy and safety of adenosine, rapid ventricular pacing and hypothermia in cerebral aneurysms clipping: a systematic review and meta-analysis.

Publisher: Springer Berlin Heidelberg Country of Publication: Germany NLM ID: 7908181 Publication Model: Electronic Cited Medium: Internet ISSN: 1437-2320 (Electronic) Linking ISSN: 03445607 NLM ISO Abbreviation: Neurosurg Rev Subsets: MEDLINE

Publication: Berlin : Springer Berlin Heidelberg
Original Publication: Berlin : Walter De Gruyter

Intracranial Aneurysm*/surgery ; Adenosine*/therapeutic use; Humans ; Hypothermia, Induced/methods ; Treatment Outcome ; Neurosurgical Procedures/methods ; Cardiac Pacing, Artificial/methods

Background and Objectives: Cerebral aneurysms in complex anatomical locations and intraoperative rupture can be challenging. Many methods to reduce blood flow can facilitate its exclusion from the circulation. This study evaluated the safety and efficacy of using adenosine, rapid ventricular pacing, and hypothermia in cerebral aneurysm clipping.
Methods: Databases (PubMed, Embase, and Web of Science) were systematically searched for studies documenting the use of adenosine, rapid ventricular pacing, and hypothermia in cerebral aneurysm clipping and were included in this single-arm meta-analysis. The primary outcome was 30-day mortality. Secondary outcomes included neurological outcomes by mRs and GOS, and cardiac outcomes. We evaluated the risk of bias using ROBIN-I, a tool developed by the Cochrane Collaboration. OpenMetaAnalyst version 2.0 was used for statistical analysis and I2 measured data heterogeneity. Heterogeneity was defined as an I ²  > 50%.
Results: Our systematic search yielded 10,100 results. After the removal of duplicates and exclusion by title and abstract, 64 studies were considered for full review, of which 29 were included. The overall risk of bias was moderate. The pooled proportions of the adenosine analysis for the different outcomes were: For the primary outcome: 11,9%; for perioperative arrhythmia: 0,19%; for postoperative arrhythmia: 0,56%; for myocardial infarction incidence: 0,01%; for follow-up good recovery (mRs 0-2): 88%; and for neurological deficit:14.1%. In the rapid ventricular pacing analysis, incidences were as follows: peri operative arrhythmia: 0,64%; postoperative arrhythmia: 0,3%; myocardial infarction: 0%. In the hypothermia analysis, the pooled proportion of 30-day mortality was 11,6%. The incidence of post-op neurological deficits was 35,4% and good recovery under neurological analysis by GOS was present in 69.2%.
Conclusion: The use of the three methods is safe and the related complications were very low. Further studies are necessary, especially with comparative analysis, for extended knowledge.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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Keywords: Adenosine; Aneurysm clipping; Cerebral aneurysm; Hypothermia; Rapid ventricular pacing

K72T3FS567 (Adenosine)

Date Created: 20240510 Date Completed: 20240510 Latest Revision: 20240710

20240711

10.1007/s10143-024-02450-9

38730072