Intraoperative Aneurysmal Rupture and Management

ABSTRACT

OBJECTIVE: The rupture of an aneurysm during operation is an event that can be considered grave. The authors present the retrospective analysis of 10 cases of intraoperative rupture in 145 consecutive aneurysm procedure. METHODS: Of 10 cases of intraoperative rupture, two cases were ruptured at predissection period, six cases during dissection and two cases during clip application. RESULTS: The causes of intraoperative aneurysm rupture in our 10 cases were forceful and blunt dissection(4 cases), excessive brain retraction(2 cases), poor exposure of aneurysm neck(1 case), poor clip application(1 case), excessive removal of aneurysmal intracerebral hematoma(1 case), unknown(1 case that was ruptured during anesthesia or craniotomy). Methods of management of nine intraoperative rupture except one of rupture during craniotomy were temporary clipping to the parent artery(3 cases), tentative aneurysm clipping(2 cases), temponade with cottonid and suction(2 cases), and induced hypotension(2 cases). The final outcome of 10 cases of intraoperative aneurysmal rupture was good in 5, fair in 1, poor in 1 and dead in 2 cases. Especially cases that were ruptured during predissection period and case that were managed with induced hypotension were poor result. CONCLUSION: The use of meticulous microsurgical technique with sharp dissection around the aneurysm, a systematic contingency plan for dealing with sudden hemorrhage and the judicious use of temporary clips should serve to minimize the adverse effect of intraoperative rupture on overall management morbidity and mortality.