{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:26:30Z","timestamp":1777983990589,"version":"3.51.4"},"reference-count":16,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Temporary arterial occlusion (TAO) is a key adjunct in microsurgical clipping of middle cerebral artery (MCA) aneurysms, but its safe duration and impact on perioperative ischemia\u2014particularly in subarachnoid hemorrhage (SAH)\u2014remain uncertain. Methods: A retrospective cohort of 245 patients undergoing microsurgical clipping of MCA aneurysms (154 incidental, 91 SAH) at a tertiary neurovascular center (2010\u20132020) was analyzed. TAO use, cumulative duration (&gt;5, &gt;8, &gt;10, &gt;15 min), number of applications, and occlusion site were extracted alongside clinical, radiographic, and outcome data. The primary endpoint was perioperative ischemia within 48 h; secondary endpoints included clinically relevant cerebral vasospasm (CVS), intraoperative rupture, and functional outcome (mRS) at discharge and 6 months. Multivariable logistic and ordinal regression models adjusted for demographic, aneurysmal, and treatment covariates. Results: TAO was used in 134 cases (54.7%; mean total duration 10.4 \u00b1 8.7 min). In the overall cohort, TAO (presence or duration) was not independently associated with perioperative ischemia or CVS. In the SAH subgroup, cumulative TAO &gt; 5 min conferred an approximately sixfold higher odds of ischemia (p = 0.012; OR 6.33), whereas no threshold was significant in incidental aneurysms. Female sex, M2 location, SAH at admission, and initial GCS &lt; 9 independently predicted ischemia; female sex, higher ASA grade, larger size, irregular morphology, and SAH predicted CVS. SAH and aneurysm wall calcification were associated with worse 6-month mRS. Conclusions: TAO appears safe in elective clipping of incidental MCA aneurysms when applied judiciously, but cumulative durations beyond 5 min substantially increase ischemia risk in SAH patients. TAO management should therefore be individualized by rupture status, neurological grade, and aneurysm morphology rather than a single universal time limit.<\/jats:p>","DOI":"10.3390\/brainsci16050449","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:40:12Z","timestamp":1777981212000},"page":"449","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balancing Time and Risk: Temporary Arterial Occlusion in Middle Cerebral Artery Aneurysm Surgery"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8964-8388","authenticated-orcid":false,"given":"Philipp","family":"Geiger","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical University Innsbruck, 6020 Tyrol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Preuss-Hernandez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University Innsbruck, 6020 Tyrol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9354-4669","authenticated-orcid":false,"given":"Daniel","family":"Pinggera","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University Innsbruck, 6020 Tyrol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudius","family":"Thom\u00e9","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University Innsbruck, 6020 Tyrol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2258-1032","authenticated-orcid":false,"given":"Ondra","family":"Petr","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University Innsbruck, 6020 Tyrol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1001\/jamaneurol.2019.0006","article-title":"Worldwide Incidence of Aneurysmal Subarachnoid Hemorrhage According to Region, Time Period, Blood Pressure, and Smoking Prevalence in the Population: A Systematic Review and Meta-analysis","volume":"76","author":"Etminan","year":"2019","journal-title":"JAMA Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3613","DOI":"10.1161\/STROKEAHA.113.002390","article-title":"Review of cerebral aneurysm formation, growth, and rupture","volume":"44","author":"Chalouhi","year":"2013","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Zhou, Z., Lan, W., and Yu, J. 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Neurosci."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/5\/449\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:06:35Z","timestamp":1777982795000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/5\/449"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["brainsci16050449"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16050449","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]}}}