Analysis of Intraoperative Rupture in Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: The authors report the various factors which correlated with the intraoperative rupture during aneurysm surgery. METHODS: Retrospective study was done in patients who had been perfomed aneurysmal neck clipping by same surgeon from January 1998 to May 2000. A total of 121 patients were operated by using the microsurgical technique of aneurysmal neck clipping and intraoperative ruptures occurred during dissection in 19 cases and aneurysmal neck clipping in 12 cases. In this study, the incidence of intraoperative rupture was 25.6%. We analyzed the followings: preoperative neurologic status(Hunt-Hess grade), preoperative hemorrhage volume on computed tomography(Fisher grade), timing of operation, aneurysm location, aneurysm size, aneurysm direction, shape of the aneurysmal neck, prescence of atherosclerotic plaque around aneurysmal neck and parent vessel and Glasgow outcome scale score. RESULTS: Hunt-Hess grade, Fisher grade, timing of operation, aneurysm location, aneurysm size and direction of the aneurysm had not associated with intraoperative rupture. However, the incidence of intraoperative aneurysmal rupture during surgery was higher in patients whose anterior communicating artery aneurysm was directed inferiorly and aneurysmal neck was broad. The GOS score and the prescence of atherosclerotic plaque around the aneurysmal neck and parent vessel also correlated with the intraopertive rupture but more closely influenced by neck clipping than dissection. CONCLUSION: Surgeons should keep in mind the use of careful microsurgical sharp dissection especially in cases of inferiorly directed anterior communicating artery, broad-neck aneurysm and presence of atherosclerotic plaque around aneurysmal neck and parent vessels.

Ring Clips for ICA Aneurysm Protruding Inferiorly: Report of Five Cases

The development of more appropriate shapes of aneurysm clips will hopefully enable excellent clipping of most types of difficult aneurysms. The clipping of internal carotid artery(ICA) aneurysms protruding inferiorly is relatively difficult and has the high risk of premature rupture during operation using conventional clips. We report five cases of ICA aneurysms protruding inferiorly in the operative field. All aneurysms were successfully clipped with ring clips without difficulty. Our results suggest that the ring clips rather than conventional clips were appropriate in the ICA aneurysm protruding inferiorly in the operative field.