Intraoperative rupture of cerebral aneurysms and use of temporary arterial occlusion

Abstract

The aim was to analyze the risk factors for intraoperative rupture (IR) of cerebral aneurysm and for temporary clips (TC) use, as well as their influence on the final postoperative outcome. Retrospective study was done 72 IR patients, and on 75 TC patients. For patients with or without IR, as well as for the patients with or without TK, outcome of the treatment, aneurysm size and localization, preoperative clinical state and operative timing was analyzed, and statistical significance of obtained differences was tested. IR occurred in 40% of anterior cerebral artery aneurysms and in 16.7% of internal carotid artery aneurysms (p > 0.05), while TCs were used in 52% of middle cerebral artery aneurysms and 34.8% of internal carotid artery aneurysms (p > 0.05). Average size was 17.3 mm for aneurysms with IR and 11.7 mm for those without IR (p > 0.05). Aneurysms were significantly larger in patients with TCs, than in patients without TCs (16.7 mm and 9.4 mm respectively, p < 0.05). Preoperative period was 10.2 days for patients with IR, and 16.8 days for patients without IR (p < 0.05). Favorable outcome was observed in 71.4% of patients with IR and in 70.6% of those without IR, as well as in 76.4% of patients who required TC and in 75.6% of cases without TC (p > 0.05). Average duration of temporary occlusion was 5.8 min for patients with favorable outcome and 15 min for patients with poor outcome (p < 0.05). Incidence of IR mostly depended on the duration of preoperative interval, while the frequency of TC use depended mostly on aneurysm size. IR did not influence the surgical outcome, as well as TC use, if the occlusion was shorter than 8-10 min.