Vascular Complications Following the Surgical Treatment of Ruptured Intracranial Aneurysms

Abstract

Introduction: The surgical complications influence to a great extent the outcome of the aneurysm clipping and present a major factor in favor of the endovascular treatment of ruptured intracranial aneurysms. Aim: The aim of this study is to determine the vascular surgical complications ratios, to analyze the causes and to propose means for their avoidance. Material and Methods: A prospective study of 72 patients with 77 cerebral aneurysms was conducted for a period of 6 years (2008 - 2013). Only the results of the surgically clipped 72 ruptured aneurysms were analyzed. Patients were assessed preoperatively according to the Hunt & Hess grading system as follows: grade I, II - 40 pts (55.5%); grade III - 22 pts (30.6%) and grade IV, V - 10 pts (13.9%). The “vascular” surgical complications were defined as: 1. intraoperative aneurismal rupture; 2. occlusion or stenosis of an afferent, efferent or perforating vessel; 3. incomplete aneurysm clipping; 4. thrombosis of a cerebral artery. Results: Intraoperative aneurismal rupture occurred in 10 cases (13.9%) - in 4 of them while dissecting the aneurysm and in the other 6 during the clip application. The arterial occlusion or stenosis rate is 9.7% (7 pts). The aneurysm was incompletely clipped in 2.8% (2 cases). Cerebral artery thrombosis was angiographicaly verified in 2 patients (2.8%) - both in the paraclinoid segment of the ICA. The reasons for these complications were thoroughly analyzed and some recommendations to prevent them were proposed. Conclusions: Surgical lesions to the vessels can be prevented, controlled or corrected by improving the microsurgical technique and routine application of intraoperative or immediate postoperative angiography.