Causes and evaluation of postoperative deterioration due to surgical procedure in patients with ruptured cerebral aneurysms

Abstract

Poor outcomes may be caused by the surgical procedure for ruptured cerebral aneurysm. This study reviewed 1025 patients who underwent surgery for ruptured cerebral aneurysms and found 28 patients (2.7%) with poor outcomes due to the surgical procedure. Classification of these 28 cases according to the site of aneurysm showed 9/285 (3.2%) cases were located in the internal carotid artery, 5/185 (2.7%) in the middle cerebral artery, and 14/189 (7.4%) in the vertebrobasilar artery (VBA). Classification according to preoperative Hunt and Kosnik grading showed 7/399 (1.8%) cases were in grade I, 1/85 (1.2%) in grade Ia, 7/181 (3.9%) in grade II, 12/212 (5.7%) in grade III, and 1/133 (0.8%) in grade IV. Classification by age showed 19/879 (2.2%) patients were under 70 years old, and 9/146 (6.2%) were 70 years or over. Causes of deterioration were perforator injury, postoperative intracerebral hemorrhage, postoperative re-bleeding, parent artery occlusion, etc. Poor outcomes were often seen in patients with VBA aneurysms, Hunt and Kosnik grade III, and age 70 years old or over. Perforator injuries and postoperative re-bleeding due to incomplete clipping were particularly present in cases located on the VBA. Complete clipping should be achieved by appropriate dissection of the aneurysm, with temporary occlusion of the parent artery if necessary, to obtain good outcome.