{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T19:32:46Z","timestamp":1760470366008,"version":"3.44.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Most studies concerning intraoperative temporary arterial occlusion overlook the period between and after clip placement.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>OBJECTIVE:<\/jats:title>\n            <jats:p>To analyze the brain tissue oxygen tension through the process by which anterograde arterial blood flow is re-established after temporary clipping (TR).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>In this prospective observational study, patients who presented to surgery for middle cerebral artery aneurysms were continuously monitored with ICM+, to obtain temporal (downstream) P<jats:sub>bt<\/jats:sub>O<jats:sub>2<\/jats:sub> levels while M1 segment temporary clips were applied and removed. P<jats:sub>bt<\/jats:sub>O<jats:sub>2<\/jats:sub> changes were analyzed and compared with the clipping phase, and measures of exposure to hypoxia were defined and assessed during both phases and used in a model to test the impact of extending them.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Eighty-six TRs (20 patients) were recorded. The mean acquired amount of time per clip release (CR) event was 336.7 seconds. Temporary clip removal produced specifically shaped, highly individual P<jats:sub>bt<\/jats:sub>O<jats:sub>2<\/jats:sub> curves that correlated with their corresponding clipping phase events but developing slower and less consistently. The CR phase was responsible for greater cumulative exposure to hypoxia than the clip application phase through the first and second minutes of each. In our model, the duration of the TR phase was mostly responsible for the total exposure to hypoxia, and longer CR phases reduced the mean exposure to hypoxia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION:<\/jats:title>\n            <jats:p>During the clip removal phase, the brain tissue is still exposed to oxygen levels that are significantly below the baseline, reverting through a singular, dynamic process. Therefore, it must be regarded by surgeons with the same degree of attention as its counterpart.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1227\/neu.0000000000001865","type":"journal-article","created":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T08:00:09Z","timestamp":1643788809000},"page":"475-484","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["The Importance of the Temporary Clip Removal Phase on Exposure to Hypoxia: On-Line Measurement of Temporal Lobe Oxygen Levels During Surgery for Middle Cerebral Artery Aneurysms"],"prefix":"10.1227","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6510-6135","authenticated-orcid":false,"given":"Pedro Alberto","family":"Silva","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Academic Hospital Centre S\u00e3o Jo\u00e3o, Porto, Portugal;"},{"name":"Department of Clinical Neurosciences, Faculty of Medicine, University of Porto, Porto, Portugal;"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0340-9808","authenticated-orcid":false,"given":"Celeste","family":"Dias","sequence":"additional","affiliation":[{"name":"Department of Intensive Medicine, Academic Hospital Centre S\u00e3o Jo\u00e3o, Porto, Portugal;"},{"name":"Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2367-8338","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Vilarinho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Academic Hospital Centre S\u00e3o Jo\u00e3o, Porto, Portugal;"},{"name":"Department of Clinical Neurosciences, Faculty of Medicine, University of Porto, Porto, Portugal;"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4140-248X","authenticated-orcid":false,"given":"Ana","family":"Vaz Ferreira","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Academic Hospital Centre S\u00e3o Jo\u00e3o, Porto, Portugal;"},{"name":"Department of Clinical Neurosciences, Faculty of Medicine, University of Porto, Porto, Portugal;"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9136-873X","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Cerejo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Academic Hospital Centre S\u00e3o Jo\u00e3o, Porto, Portugal;"},{"name":"Department of Clinical Neurosciences, Faculty of Medicine, University of Porto, Porto, Portugal;"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7527-8187","authenticated-orcid":false,"given":"Rui","family":"Vaz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Academic Hospital Centre S\u00e3o Jo\u00e3o, Porto, Portugal;"},{"name":"Department of Clinical Neurosciences, Faculty of Medicine, University of Porto, Porto, Portugal;"}]}],"member":"276","published-online":{"date-parts":[[2022,2,3]]},"reference":[{"key":"R1-20250819","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4103\/sni.sni_410_16","article-title":"Safe time duration for temporary middle cerebral artery occlusion in aneurysm surgery based on motor-evoked potential monitoring","volume":"8","author":"Tanabe","year":"2017","journal-title":"Surg Neurol Int."},{"key":"R2-20250819","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/j.wneu.2017.05.036","article-title":"Somatosensory evoked potentials during temporary arterial occlusion for intracranial aneurysm surgery: predictive value for perioperative stroke","volume":"104","author":"Kashkoush","year":"2017","journal-title":"World Neurosurg."},{"issue":"3-4","key":"R3-20250819","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.wneu.2013.02.067","article-title":"The impact of temporary artery occlusion during intracranial aneurysm surgery on long-term clinical outcome: part II. 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