Flow arrest in intracranial aneurysm surgery: Temporary clip, adenosine, rapid ventricular pacing, and balloon test occlusion - A narrative review.

Abstract

Precise and controlled interruption of cerebral blood flow is essential in modern cerebrovascular surgery, where safe manipulation of aneurysms often depends on creating short intervals of reduced perfusion. A variety of strategies (temporary arterial clipping, adenosine-induced transient circulatory arrest, rapid ventricular pacing, and balloon test occlusion) provide distinct mechanisms for achieving flow arrest, each with unique advantages, limitations, and optimal clinical contexts. Although the use of flow-arrest-assisted neurosurgery has become increasingly rare, it remains an important adjunct in selected cases, where detailed knowledge of these techniques can be indispensable for safe and effective treatment. This narrative review synthesizes current knowledge on the physiological basis, technical execution, and perioperative considerations of these four principal modalities. Taken together, these techniques allow hemodynamic control in a wide spectrum of neurovascular interventions. A nuanced understanding of their mechanisms and indications is essential for minimizing ischemic risk, optimizing surgical exposure, and improving patient outcomes.