Emergency treatment of ruptured or avulsed aneurysms at their necks during intracranial aneurysm operation

Abstract

Objective To investigate the main reasons and treatment methods of ruptured or avulsed intracranial aneurysms at their necks during microsurgical clipping, and to increase the success rate of aneurysm surgery when unexpected event occurred, so as to improve the operative efficacy of intracranial aneurysms. Methods A retrospective analysis was performed in clinical data of 8 patients appeared ruptured or avulsed aneurysms at their necks during operation, admitted to our hospital from January 2009 to September 2013. Their clinical results of these patients were summarized. The characteristics of aneurysms, the reasons of ruptured or avulsed aneurysms during surgery, and the surgical treatments were analyzed. Results Eight patients with ruptured or avulsed aneurysms at their necks during operation belonged to normal internal carotid artery aneurysms, and the rupturing or avulsing just occurred in the process of separating or clipping of the necks of aneurysms. Three patients had small neck lacerations, by temporarily blocking the proximal parent vessels and clipping the necks of aneurysms using ordinary curved aneurysm clip, returning to preoperative levels soon; and the GOS scores were 5 points one month after operation. Another 5 patients could not be clipped the necks of aneurysms by ordinary aneurysm clip, only by using the cross-vascular clamp to clip the necks of aneurysms or/and a part of the parent vessels to stop bleeding; 1-2 pieces of cross-vascular clamp were used in each patient and totally 8 pieces were used; 5 points of GOS scores were got in 4 and 4 points were got in one patient one month after operation. Conclusions The rupture or avulsion of intracranial aneurysms at their necks during clipping can be foreseen and prepared well in advance. The correct application of aneurysm clip can improve operative efficacy and reduce postoperative complications. The rational use of cross vascular clips is an effective emergency measure to treat the avulsion or rupture of aneurysms at their necks. Key words: Intracranial aneurysm; Microsurgery; Aneurysm neck; Rupture; Avulsion