Chen S F, Kato Y, Kumar A, Tan G W, Oguri D, Oda J, Watabe T, Imizu S, Sano H, Wang Z X
Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China.
Department of Neurosurgery, Fujita Health University Banbuntane Hotokukai Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
J Clin Neurosci. 2016 Dec;34:63-69. doi: 10.1016/j.jocn.2016.01.045. Epub 2016 Sep 28.
Intraoperative rerupture (IOR) during clipping of cerebral aneurysms is a difficult complication of microneurosurgery. The aim of this study was to evaluate the incidence of IOR and analyze the strategies for controlling profound hemorrhage. A total of 165 patients with unruptured intracranial aneurysms and 46 patients with subarachnoid hemorrhage (SAH) treated surgically between April 2010 and March 2011, were reviewed. The data were collected with regard to age, sex, presence of symptoms, confounding factors and strategy for controlling intraoperative hemorrhage was analyzed in terms of location of aneurysms, timing of rupture and severity of IOR. 211 patients with 228 aneurysms were treated in this series. There were a total of six IORs which represented an IOR rate of 2.84% per patient and 2.63% per aneurysm. The highest ruptures rates occurred in patients with internal carotid artery aneurysms (25%). Surgeries in the group with ruptured aneurysms had a much higher rate of IOR compared with surgeries in the group with unruptured aneurysms. Of the six IOR aneurysms, one occurred during predissection, four during microdissection and one during clipping. One was major IOR, three were moderate and two were minor. Intraoperative rupture of an intracranial aneurysm can be potentially devastating in vascular neurosurgery. Aneurysm location, presence of SAH and surgical experience of the operating surgeon seem to be important factors affecting the incidence of IOR.
脑动脉瘤夹闭术中的术中再破裂(IOR)是显微神经外科手术中一种棘手的并发症。本研究的目的是评估IOR的发生率,并分析控制严重出血的策略。回顾了2010年4月至2011年3月期间接受手术治疗的165例未破裂颅内动脉瘤患者和46例蛛网膜下腔出血(SAH)患者。收集了关于年龄、性别、症状、混杂因素的数据,并根据动脉瘤的位置、破裂时间和IOR的严重程度分析了控制术中出血的策略。本系列共治疗了211例患者的228个动脉瘤。共有6例IOR,患者的IOR发生率为2.84%,动脉瘤的IOR发生率为2.63%。颈内动脉动脉瘤患者的破裂率最高(25%)。与未破裂动脉瘤组的手术相比,破裂动脉瘤组的手术IOR发生率要高得多。在6例IOR动脉瘤中,1例发生在预分离期间,4例发生在显微分离期间,1例发生在夹闭期间。1例为严重IOR,3例为中度,2例为轻度。颅内动脉瘤的术中破裂在血管神经外科手术中可能具有潜在的毁灭性。动脉瘤位置、SAH的存在以及手术医生的手术经验似乎是影响IOR发生率的重要因素。