Intraoperative aneurysmal rupture

Intraoperative aneurysmal rupture has a negative effect on prognosis of patients who received aneurysmal surgery. In order to decrease the incidence of this complication in the future and to find out the adequate management methods of this complication, the author performed this study. The author retrospectively reviewed medical and operation records of 613 consecutive patients who received intracranial aneurysm surgery between March, 1987 and May, 1995. The author investigated the incidence of this complication, the timing of its occurrence, factors associated with its occurrence, and its causes and management methods according to the timing of its occurrence and the types of aneurysm rupture. This complication occurred in 109 cases (18%). The majority of ruptures occurred during aneurysm dissection (43%) or clip application (49%). This complication was associated with an unfavorable outcome (p < 0.05). The planned elective use of temporary clipping during dissection or clipping of the aneurysm decreased the incidence of this complication (p < 0.01). High incidence of this complication occurred during operation for anterior communicating artery aneurysms (p < 0.05). The major cause of rupture during dissection was blunt dissection (89%) and, during clipping, was poor clip application (72%). Temporary clipping of the parent vessels, application of a cotton sponge over the tear of the aneurysm with gentle pressure with suction and tentative clip application to the distal sac of aneurysm were frequently used for management of this complication. Rupture at the base of the aneurysm showed poor outcome even if the tear was managed with microsuture repair. The author concludes that the meticulous control of blood pressure during intubation, sharp microsurgical dissection of the aneurysm, frequent use of planned elective temporary clipping, and clip application after complete dissection of the aneurysm from the surrounding structures may minimize the incidence of intraoperative rupture.