Intraoperative rupture in the surgical treatment of patients with intracranial aneurysms.
Intraoperative rerupture (IOR) during clipping of cerebral aneurysms is a difficult complication of microneurosurgery. The aim of this study was to evaluate the incidence of IOR and analyze the strategies for controlling profound hemorrhage. A total of 165 patients with unruptured intracranial aneurysms and 46 patients with subarachnoid hemorrhage (SAH) treated surgically between April 2010 and March 2011, were reviewed. The data were collected with regard to age, sex, presence of symptoms, confounding factors and strategy for controlling intraoperative hemorrhage was analyzed in terms of location of aneurysms, timing of rupture and severity of IOR. 211 patients with 228 aneurysms were treated in this series. There were a total of six IORs which represented an IOR rate of 2.84% per patient and 2.63% per aneurysm. The highest ruptures rates occurred in patients with internal carotid artery aneurysms (25%). Surgeries in the group with ruptured aneurysms had a much higher rate of IOR compared with surgeries in the group with unruptured aneurysms. Of the six IOR aneurysms, one occurred during predissection, four during microdissection and one during clipping. One was major IOR, three were moderate and two were minor. Intraoperative rupture of an intracranial aneurysm can be potentially devastating in vascular neurosurgery. Aneurysm location, presence of SAH and surgical experience of the operating surgeon seem to be important factors affecting the incidence of IOR.
Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China.
S F
SF
Chen
Department of Neurosurgery, Fujita Health University Banbuntane Hotokukai Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan. Electronic address: csfsong143@aliyun.com.
Y
Y
Kato
Department of Neurosurgery, Nizam's Institute of Medical Science, Hyderabad, India.
A
A
Kumar
Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China.
G W
GW
Tan
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
D
D
Oguri
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
J
J
Oda
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
T
T
Watabe
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
S
S
Imizu
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
H
H
Sano
Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China.
Z X
ZX
Wang
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000601:surgery; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014786:Vision Disorders / Q000209:etiology / Q000628:therapy
Cerebral aneurysm; Clipping surgery; Intraoperative rupture