{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:04:03Z","timestamp":1787738643384,"version":"build-2784847793"},"reference-count":47,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To date, treatment of complex unruptured intracranial aneurysms (UIAs) remains challenging. Therefore, advanced techniques are required to achieve an optimal result in treating these patients safely. In this study, the safety and efficacy of rapid ventricular pacing (RVP) to facilitate microsurgical clip reconstruction was investigated prospectively in a joined neurosurgery, anesthesiology, and cardiology study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients with complex UIAs were prospectively enrolled. Both the safety and efficacy of RVP were evaluated by recording cardiovascular events and outcomes of patients as well as the amount of aneurysm occlusion after the surgical clip reconstruction procedure. A questionnaire was used to evaluate aneurysm preparation and clip application under RVP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Twenty patients (mean age 51.6 years, range 28\u201366 years) were included in this study. Electrode positioning was easy in 19 (95%) of 20 patients, and removal of electrodes was easily accomplished in all patients (100%). No complications associated with the placement of the pacing electrodes occurred, such as cardiac perforation or cardiac tamponade. RVP was applied in 16 patients. The mean aneurysm size was 11.1 \u00b1 5.5 mm (range 6\u201330 mm). RVP proved to be a very helpful tool in aneurysm preparation and clip application in 15 (94%) of 16 patients. RVP was used for a mean duration of 60 \u00b1 25 seconds, a mean heart rate of 173 \u00b1 23 bpm (range 150\u2013210 bpm), and a reduction of mean arterial pressure to 35\u201355 mm Hg. RVP leads to softening of the aneurysm sac facilitating its mobilization, clip application, and closure of the clip blades. In 2 patients, cardiac events were documented that resolved without permanent sequelae in both. In every patient with successful RVP (n = 14) a total or near-total aneurysm occlusion was documented. In the 1 patient in whom the second RVP failed due to pacemaker electrode dislocation, additional temporary clipping was required to secure the aneurysm, but was not as sufficient as RVP. This led to an incomplete clipping of the aneurysm and finally a remnant on postoperative digital subtraction angiography. A pacemaker lead dislocation occurred in 3 (19%) of 16 patients, but intraoperative repositioning requires less than 20 seconds. Outcome was favorable in all patients according to the modified Rankin Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>To the best of the authors\u2019 knowledge this is the first prospective interdisciplinary study of RVP use in patients with UIAs. RVP is an elegant technique that facilitates clip reconstruction in complex UIAs. The safety of the procedure is good. However, because this procedure requires extensive preoperative cardiological workup of the patient and an experienced neurosurgery and neuroanesthesiology team with much cerebrovascular expertise, actually it remains reserved for selected elective cases and highly specialized centers.<\/jats:p>\n                    <jats:p>Clinical trial registration no.: NCT02766972 (clinicaltrials.gov)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2016.11.jns161420","type":"journal-article","created":{"date-parts":[[2017,8,18]],"date-time":"2017-08-18T09:59:32Z","timestamp":1503050372000},"page":"1741-1752","source":"Crossref","is-referenced-by-count":25,"title":["Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trial"],"prefix":"10.3171","volume":"128","author":[{"given":"Juergen","family":"Konczalla","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Platz","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Fichtlscherer","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospital Frankfurt, Goethe University; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitham","family":"Mutlak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Strouhal","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Seifert","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"1933","DOI":"10.1016\/j.wneu.2015.08.038","article-title":"Transient cardiac arrest induced by adenosine: a tool for contralateral clipping of internal carotid artery-ophthalmic segment aneurysms","volume":"84","author":"Andrade-Barazarte H","year":"2015","unstructured":"Andrade-Barazarte H, Luostarinen T, Goehre F, Kivelev J, Jahromi BR, Ludtka C, : Transient cardiac arrest induced by adenosine: a tool for contralateral clipping of internal carotid artery-ophthalmic segment aneurysms. 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