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

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Abstract

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 I2 > 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.

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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

AVM:

Arteriovenous Malformation

AV:

Atrioventricular

GOS:

Glasgow Outcome Scale

RVP:

Rapid Ventricular Pacing

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

PROSPERO:

International Prospective Register of Systematic Reviews

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Acknowledgements

The authors would like to thank Rhanderson Cardoso, MD, for the support in conducting this research. We would also like to thank the Meta-Analysis Academy (Instagram: @metaanalysis.academy) for the immense support in the elaboration of this project. The authors would also like to especially thank Matheus de Andrade Bannach, MD, our senior author and research mentor for his tireless contribution to the advancement of all our projects.

Funding

This research did not receive any specific grant from any government, private, or non-profit funding source.

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Authors and Affiliations

  1. School of Surgery and Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil

    Gabriela Borges Nager

  2. Department of Surgical Specialities, Neurosurgery Teaching and Assistance Unit, Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil

    Julia Pereira Muniz Pontes

  3. Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil

    Ofonime Chantal Udoma-Udofa

  4. School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Fernando Cotrim Gomes

  5. School of Medicine, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil

    Anna Laura Lima Larcipretti

  6. Faculty of Medicine, National University of Rosario, Rosario, Argentina

    Jessica Sales de Oliveira

  7. School of Medicine, University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil

    Caroline Serafim Dagostin

  8. Department of Surgery, Neurology and Neurosurgery Unit, Federal University of Goiás, Goiania, Brazil

    Mateus Neves Faria Fernandes

  9. Department of Surgery, Neurology and Neurosurgery Unit, Federal University of Goiás, Goiania, Brazil

    Matheus de Andrade Bannach

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  1. Gabriela Borges Nager
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  9. Matheus de Andrade Bannach
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Contributions

Conception and design of the research: J.P.M.P., G.B.N., and M.A.B.Acquisition of data: J.P.M.P., F.C.G., O.C.U.U., and G.B.N.Analysis and interpretation of the data collected: J.P.M.P., G.B.N., F.C.G., O.C.U.U., and M.A.B.Writing manuscript: O.C.U.U., G.B.N., F.C.G., J.P.M.P., and M.A.B.Critical revision of the manuscript for intellectual content: ALL AUTHORS.Coordination and supervision of project: M.A.B.Submission of manuscript: O.C.U.U.

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Correspondence to Gabriela Borges Nager.

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Nager, G.B., Pontes, J.P.M., Udoma-Udofa, O.C. et al. Efficacy and safety of adenosine, rapid ventricular pacing and hypothermia in cerebral aneurysms clipping: a systematic review and meta-analysis. Neurosurg Rev 47, 215 (2024). https://doi.org/10.1007/s10143-024-02450-9

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