[Intraoperative rupture of cerebral aneurysm--incidence and risk factors].

ABSTRACT

OBJECTIVE: To reveal and assess risk factors for intraoperative rupture (IOA) of aneurysms, which will reduce the incidence of this complication and improve the outcome of treatment. METHODS: Direct surgical interventions made in 610 cerebral aneurysms at the Vascular Department of N.N. Burdenko Research Institute of Neurosurgery, Russian Academy of Medical Sciences, in 2002 to 2005 were analyzed in 519 patients. Under study were the following factors onset of IOA; site and anatomic and topographic features of aneurysms; time of an operation (acute or cold subarachnoidal hemorrhage), presence or absence of hemorrhage in the history, rate and severity of hemorrhage (according to the Hunt-Hess classification), temporary clipping of the nutrient arteries. RESULTS: The incidence of IOR was 11.7% of the operated aneurysms and 13.7% of the patients. Ruptures occurred during aneurysmal manipulations in 96% of cases. Moderate and significant hemorrhages requiring a surgeon to make additional measures to improve them more frequently occurred in IOR. The highest rate of IOR was recorded at surgery for aneurysms of the anterior cerebral artery--the anterior communicating artery. The incidence of ruptures increased with their greater sizes. There was a significant increase in the incidence of IOR in aneurysms with diverticula (p = 0.004) and with wide necks (p = 0.04). The level of IOR in the patients operated on within the first 3 weeks after SAK was 3 times higher than in those operated on in the cold period (p < 0.05). The incidence of IOR was rather low in the treatment of asymptomatic aneurysms (2.5%). The risk for IOR was higher in patients with recurring hemorrhage. Preventive temporary occlusion substantially lessens the risk of IOR. CONCLUSION: The low rate of IOA in the treatment of asymptomatic aneurysms is another argument in favor of the development of surgery for unruptured asymptomatic aneurysms. Timely temporary clipping of the nutrient artery at surgery substantially reduces the risk of IOR in all cases.