Abstract
The incidence and associated mortality of major intraoperative rupture (MIOR) in intracranial aneurysm surgery is diverse. One possible reason is that many studies failed to consider and properly adjust the factor of surgical experience in the context. We conducted this study to clarify the role of surgical experience on MIOR and associated outcome. 538 consecutive intracranial aneurysm surgeries performed on 501 patients were enrolled in this study. Various potential predictors of MIOR were evaluated with stratified analysis and multivariate logistic regression. The impact of surgical experience and MIOR on outcome was further studied in a logistic regression model with adjustment of each other. The outcome was evaluated using the Glasgow Outcome Scale one year after the surgery. Surgical experience and preoperative Glasgow Coma Scale (GCS) were identified as independent predictors of MIOR. Experienced neurovascular surgeons encountered fewer cases of MIOR compared to novice neurosurgeons (MIOR, 18/225, 8.0% vs. 50/313, 16.0%, P = 0.009). Inexperience and MIOR were both associated with a worse outcome. Compared to experienced neurovascular surgeons, inexperienced neurosurgeons had a 1.90-fold risk of poor outcome. On the other hand, MIOR resulted in a 3.21-fold risk of unfavorable outcome compared to those without it. Those MIOR cases managed by experienced neurovascular surgeons had a better prognosis compared with those managed by inexperienced neurosurgeons (poor outcome, 4/18, 22% vs. 30/50, 60%, P = 0.013).
Highlights
Intraoperative rupture (IOR) is an unavoidable event in microsurgery for intracranial aneurysm
This paper presents a study aimed to identify the predictors of major intraoperative rupture (MIOR), the role of surgical experience
MIOR was defined as all the intraoperative aneurysm ruptures that happened during brain retraction, aneurysm dissection and clipping and needed further manners to control bleeding, such as induced profound hypotension, local packing, large bore suction, and temporary clipping
Summary
Intraoperative rupture (IOR) is an unavoidable event in microsurgery for intracranial aneurysm. As to risk factors of IOR and its effect on outcome, there were only several articles discussing such subjects in literature[1,2,3,4,5,6,7,8]. Most of these studies were relatively small-scale, less comprehensive, and possibly lacking a more rigorous research design and statistics. The ability to identify the authentic predictors of IOR and its impact on outcome was limited These relevant studies seldom took into account the factor of surgical experience and put it as a possible risk factor
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