title: Analysis of the relationship between different bleeding positions on intraoperative rupture anterior circulation aneurysm and surgical treatment outcome.
abstract: BACKGROUND
  It is well recognized that intraoperative aneurysm rupture (IAR) is a serious event that is difficult to manage and has a relatively serious influence on a patient's prognosis. The aim of this study was to evaluate the prognostic value of different bleeding positions of IAR in patients, and to describe the technique that the authors have used to clip the ruptured aneurysms.
  
  
  METHODS
  From May 2009 to March 2012, a total of 148 aneurysms in 135 consecutive patients in our institution underwent clipping surgeries, and 31 IARs occurred in 30 patients. The clinical data of all patients were retrospectively analyzed. Statistics analysis was performed to analyze possible factors of different bleeding positions of IARs, to assist observation.
  
  
  RESULTS
  Outcome was estimated by Glasgow outcome scale via following up or calling back within 1, 3, and 6 months after surgery: 94 patients were 5', 23 patients were 4', nine patients were 3', two patients were 2' and eight patients were 1'. There was no significant difference between the outcome of IAR and that of no intraoperative aneurysm rupture (NIAR) in Hunt-Hess groups 0-III (P = 0.802) and Hunt-Hess groups IV-V (P = 0.229), and the different bleeding positions were shown to be an important factor that significantly influences the patients' prognosis (P = 0.001).
  
  
  CONCLUSIONS
  Different bleeding positions of IAR have a significant impact on surgical outcome; IAR of the neck is the most devastating complication. If surgeons take appropriate measures according to different bleeding positions, the efficiency, accuracy and security of the operation will be improved.
authors: Department of Neurosurgery, Su Bei People's Hospital of Jiangsu Province, Yangzhou University, No. 98 West Road of Nantong, 225001, Yangzhou city, Jiangsu Province, China.
authors: Yong
authors: Y
authors: Zhen
authors: Kaixuan
authors: K
authors: Yan
authors: Hengzhu
authors: H
authors: Zhang
authors: Shaokun
authors: S
authors: Zhao
authors: Yao
authors: Y
authors: Xu
authors: Hengzhong
authors: H
authors: Zhang
authors: Liang
authors: L
authors: He
authors: Linhai
authors: L
authors: Shen
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome