Clipping of cerebral aneurysm complicated by intraoperative rupture

Abstract

Despite the development of neurosurgical treatment of brain aneurysm (BA), the problem of intraoperative aneurysm rupture (IAR) remains relevant. The IAR is the most common intraoperative complication, which, according to various authors, occurs in 5.6–35.0 % cases. There are contact and non-contact IAR. Noncontact are those that occur at the early stages of the operation, before the dissection of dura mater, when there is no mechanical effect on the aneurysm. Noncontact IAR accounts for 2.5–9.0 % of the total amount of IAR. Contact IAR occurs in 91–94 % of observations. IAR occurs predominantly in arachnoid dissection (48–81 %). The main criteria and risk factors for the IAR are the size of BA, its localization, the operation duration after the initial rupture of BA, the presence of hypertension and the severity of the patient’s condition before surgery. The greatest risk of IAR is predisposed by aneurysms of the anterior communicating artery complex — an anterior cerebral artery and internal carotid artery. Performing surgery at the early stages after aneurysm rupture in the presence of cerebral edema along with the difficult access to BA and with the need to perform sufficient traction of the brain substance is more often accompanied by IAR. IAR results in deterioration of the results of operations and an increase in mortality by 1.5–3.0 times. The prognosis of survival of patients after IAR at the stages of aneurysm isolation and clipping is more favourable than at the initial stages of surgery.