Frączek Maciej J, Błoński Miłosz J, Kliś Kornelia M, Krzyżewski Roger M, Polak Jarosław, Stachura Krzysztof, Kwinta Borys M
Faculty of Medicine, Jagiellonian University Medical College, Św. Anny 12 Street 31-008, Kraków, Poland.
Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland.
Acta Neurol Belg. 2023 Oct;123(5):1717-1724. doi: 10.1007/s13760-022-02005-z. Epub 2022 Jun 27.
Intraoperative cerebral aneurysm rupture (IOR) is a common phenomenon with a frequency of around 19%. Research regarding IOR lacks an analysis of its predictors.
We retrospectively examined all saccular aneurysms, in 198 patients with subarachnoid hemorrhage, surgically treated from 2013 to 2019. Operative reports, patient histories, blood test results, discharge summaries, and radiological data were reviewed. IOR was defined as any bleeding from the aneurysm during surgery, preceding putting a clip on its neck, regardless of how trivial.
The frequency of IOR was 20.20%. Patients with IOR had higher aneurysm dome size (9.43 ± 8.39 mm vs. 4.96 ± 2.57 mm; p < 0.01). The presence of blood clot on the aneurysm dome was significantly associated with IOR (12.50% vs. 2.53%; p < 0.01). We also associated lamina terminalis fenestration during surgery (7.50% vs. 21.52%; p = 0.04) and multiple aneurysms (5.00% vs. 18.35%; p = 0.038) with a lower risk of IOR. Glucose blood levels were also elevated in patients with IOR (7.47 ± 2.78 mmol/l vs. 6.90 ± 2.22 mmol/l; p = 0.04). Multivariate analysis associated that urea blood levels (OR 0.55, 0.33 to 0.81, p < 0.01) and multiple aneurysms (OR 0.04, 0.00 to 0.37, p = 0.014) were protective factors against the occurrence of IOR.
Large dome size of an aneurysm, a blood clot on the aneurysm dome and elevated glucose blood levels can be IOR predictive. Lamina terminalis fenestration, the appearance of multiple aneurysms, and high urea blood levels may be associated with a lower risk of such an event.
术中脑动脉瘤破裂（IOR）是一种常见现象，发生率约为19%。关于IOR的研究缺乏对其预测因素的分析。
我们回顾性研究了198例2013年至2019年接受手术治疗的蛛网膜下腔出血患者的所有囊状动脉瘤。查阅了手术报告、患者病史、血液检查结果、出院小结和放射学数据。IOR被定义为在手术过程中，在夹闭动脉瘤颈部之前，动脉瘤发生的任何出血，无论出血量多么微小。
IOR的发生率为20.20%。发生IOR的患者动脉瘤瘤顶尺寸更大（9.43±8.39毫米对4.96±2.57毫米；p<0.01）。动脉瘤瘤顶存在血凝块与IOR显著相关（12.50%对2.53%；p<0.01）。我们还发现手术中终板开窗（7.50%对21.52%；p=0.04）和多发性动脉瘤（5.00%对18.35%；p=0.038）与IOR风险较低相关。发生IOR的患者血糖水平也升高（7.47±2.78毫摩尔/升对6.90±2.22毫摩尔/升；p=0.04）。多变量分析表明血尿素水平（比值比0.55，0.33至0.81，p<0.01）和多发性动脉瘤（比值比0.04，0.00至0.37，p=0.014）是IOR发生的保护因素。
动脉瘤瘤顶尺寸大、动脉瘤瘤顶有血凝块和血糖水平升高可作为IOR的预测指标。终板开窗、多发性动脉瘤的出现和血尿素水平高可能与该事件风险较低相关。
