• World Neurosurg · Jul 2019

    Intraoperative Mannitol Administration Increases the Risk of Postoperative Chronic Subdural Hemorrhage after Unruptured Aneurysm Surgery.

    • Jaechan Park, Youngseok Kwak, Chang-Hyun Kim, Youngseop Lee, Yeon-Ju Choi, Dong-Hun Kang, and Boram Ohk.
    • Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Biomedical Research Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: jparkmd@hotmail.com.
    • World Neurosurg. 2019 Jul 1; 127: e919-e924.

    ObjectiveAlthough mannitol is used widely to facilitate brain retraction in cases of ruptured aneurysms, there is no consensus about the intraoperative administration of mannitol in the case of unruptured aneurysms. Accordingly, this study was conducted to identify an intraoperative mannitol administration strategy.MethodsMannitol was administered routinely to patients (n = 90) from January 2015 to April 2016 and not administered to patients (n = 97) from May 2016 to June 2017. The patient groups with and without mannitol administration were then compared based on the patient medical records, radiologic data, and digital recordings from an intraoperative microscope.ResultsThe patient groups with and without mannitol administration were comparable regarding patient age, number of elderly patients, sex, and aneurysm locations. No between-group difference was identified in terms of the intradural procedural time, retraction-induced cortical injury, postoperative electrolyte imbalance, symptomatic infarction, and postoperative epidural hematomas. However, the patient group without mannitol administration showed a significantly lower incidence of chronic subdural hematomas (CSDHs) >50 mL (13.3% vs. 3.1%, P = 0.010). Moreover, a multivariate analysis revealed that an advanced age (P = 0.019), male sex (P <0.001), and mannitol administration (P = 0.040) were all statistically significant risk factors for a postoperative CSDH >50 mL following unruptured aneurysm surgery.ConclusionsWithholding the administration of mannitol during a pterional or modified procedure for unruptured aneurysms was found to reduce the postoperative occurrence of a CSDH without increasing the operative difficulties or other postoperative complications.Copyright © 2019 Elsevier Inc. All rights reserved.

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