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Management of Intraoperative Rupture of Intracranial Aneurysms: Agony and Ecstasy

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Complications in Neurosurgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 130))

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Abstract

Intraoperative rupture (IOR) of an intracranial aneurysm is a serious complication, often with catastrophic consequences that are difficult to manage even by the best hands. Like most surgical complications, this one is better to avoid than to treat, but any vascular neurosurgeon should know how to deal with IOR of an aneurysm, because it is bound to occur. The aims of this study were to evaluate the incidence and factors associated with IOR during clipping of intracranial aneurysms, to analyze strategies for controlling hemorrhage in such cases, and to assess outcomes. Overall, 911 cases of intracranial aneurysms, which were treated surgically by the author during 26 years of his professional career, were reviewed. IOR was never noted during clipping of an unruptured intracranial aneurysm (65 cases) but was encountered in 49 of 846 cases (5.8%) presenting with subarachnoid hemorrhage. This complication occurred most often in cases of internal carotid artery aneurysms (22 cases; 45%), followed by anterior communicating artery aneurysms (12 cases; 24%), distal anterior cerebral artery aneurysms (6 cases; 12%), middle cerebral artery aneurysms (6 cases; 12%), and posterior circulation aneurysms (3 cases; 6%). IOR was mostly encountered during early surgery (within 3 days) after the ictus (26 cases; 53%) and most frequently occurred during dissection of the aneurysm (26 cases; 53%). Overall, 22 patients (45%) had good outcome, 18 (37%) had variable morbidity, and 9 (18%) died. Fatal consequences of IOR were noted only in cases of big or multilobulated internal carotid artery aneurysms. Detailed planning of the surgical procedure, application of meticulous microdissection techniques, and anticipation of possible intraoperative incidents during intervention aimed at clipping of an intracranial aneurysm can reduce the risk of IOR, as well as the associated morbidity and mortality.

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Conflict of Interest Statement

The author has no conflict of interest concerning the reported materials or methods.

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Authors and Affiliations

  1. Department of Neurosurgery, SDM College of Medical Sciences & Hospital, Dharwad–Hubballi, Karnataka, India

    Suresh M. Dugani

  2. Regional Neuroscience Centre, Shivakrupa Hospital, Dharwad–Hubballi, Karnataka, India

    Suresh M. Dugani

  3. Suchirayu Hospital, Dharwad–Hubballi, Karnataka, India

    Suresh M. Dugani

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  1. Suresh M. Dugani
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Correspondence to Suresh M. Dugani .

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Editors and Affiliations

  1. Department of Neurosurgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, India

    Keki E. Turel

  2. Department of Neurosurgery, Tokyo Women’s Medical University, Adachi Medical Center, Tokyo, Japan

    Mikhail F. Chernov

  3. Department of Neurosurgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India

    Hrishikesh Sarkar

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Dugani, S.M. (2023). Management of Intraoperative Rupture of Intracranial Aneurysms: Agony and Ecstasy. In: Turel, K.E., Chernov, M.F., Sarkar, H. (eds) Complications in Neurosurgery. Acta Neurochirurgica Supplement, vol 130. Springer, Cham. https://doi.org/10.1007/978-3-030-12887-6_9

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  • DOI: https://doi.org/10.1007/978-3-030-12887-6_9

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