title: Impact of Aneurysm Projection on Intraoperative Complications During Surgical Clipping of Ruptured Posterior Communicating Artery Aneurysms.
abstract: BACKGROUND
  Surgical clipping of ruptured posterior communicating artery (PCoA) aneurysms is a well-established procedure to date. However, preoperative factors associated with procedure-related risk require further elucidation.
  
  
  OBJECTIVE
  To investigate the impact of the direction of aneurysm projection on the incidence of procedure-related complications during surgical clipping of ruptured PCoA aneurysms.
  
  
  METHODS
  A total of 65 patients with ruptured PCoA aneurysms who underwent surgical clipping were retrospectively analyzed from a single-center, prospective, observational cohort database in this study. The aneurysms were categorized into lateral and posterior projection groups, depending on direction of the dome. Characteristics and operative findings of each projection group were identified. We also evaluated any correlation of aneurysm projection with the incidence of procedure-related complications.
  
  
  RESULTS
  Patients with ruptured PCoA aneurysms with posterior projection more likely presented with good-admission-grade subarachnoid hemorrhage (P = .01, χ test) and were less to also have intracerebral hematoma (P = .01). These aneurysms were found to be associated with higher incidence of intraoperative rupture (P = .02), complex clipping with fenestrated clips (P = .02), and dense adherence to PCoA or its perforators (P = .04) by univariate analysis. Aneurysms with posterior projection were also correlated with procedure-related complications, including postoperative cerebral infarction or hematoma formation (odds ratio, 5.87; 95% confidence interval, 1.11-31.1; P = .04) by multivariable analysis.
  
  
  CONCLUSIONS
  Ruptured PCoA aneurysms with posterior projection carried a higher risk of procedure-related complications of surgical clipping than those with lateral projection.
authors.affiliation: Departments of *Neurosurgery, ‡Radiology, Kurashiki Central Hospital, Kurashiki, Okayama Japan; §Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fukuda
authors.forename: Kosuke
authors.initials: K
authors.lastname: Hayashi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Yoshino
authors.forename: Takashi
authors.initials: T
authors.lastname: Koyama
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lo
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kurosaki
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013525:Surgical Instruments