Department of Neurosurgery, SDM College of Medical Sciences & Hospital, Dharwad-Hubballi, Karnataka, India.
Regional Neuroscience Centre, Shivakrupa Hospital, Dharwad-Hubballi, Karnataka, India.
Acta Neurochir Suppl. 2023;130:65-79. doi: 10.1007/978-3-030-12887-6_9.
Intraoperative rupture (IOR) of an intracranial aneurysm is a serious complication, often with catastrophic consequences that are difficult to manage even by the best hands. Like most surgical complications, this one is better to avoid than to treat, but any vascular neurosurgeon should know how to deal with IOR of an aneurysm, because it is bound to occur. The aims of this study were to evaluate the incidence and factors associated with IOR during clipping of intracranial aneurysms, to analyze strategies for controlling hemorrhage in such cases, and to assess outcomes. Overall, 911 cases of intracranial aneurysms, which were treated surgically by the author during 26 years of his professional career, were reviewed. IOR was never noted during clipping of an unruptured intracranial aneurysm (65 cases) but was encountered in 49 of 846 cases (5.8%) presenting with subarachnoid hemorrhage. This complication occurred most often in cases of internal carotid artery aneurysms (22 cases; 45%), followed by anterior communicating artery aneurysms (12 cases; 24%), distal anterior cerebral artery aneurysms (6 cases; 12%), middle cerebral artery aneurysms (6 cases; 12%), and posterior circulation aneurysms (3 cases; 6%). IOR was mostly encountered during early surgery (within 3 days) after the ictus (26 cases; 53%) and most frequently occurred during dissection of the aneurysm (26 cases; 53%). Overall, 22 patients (45%) had good outcome, 18 (37%) had variable morbidity, and 9 (18%) died. Fatal consequences of IOR were noted only in cases of big or multilobulated internal carotid artery aneurysms. Detailed planning of the surgical procedure, application of meticulous microdissection techniques, and anticipation of possible intraoperative incidents during intervention aimed at clipping of an intracranial aneurysm can reduce the risk of IOR, as well as the associated morbidity and mortality.
颅内动脉瘤术中破裂（IOR）是一种严重的并发症，往往后果严重，即使是最好的医生也难以处理。与大多数手术并发症一样，这种并发症最好是预防而不是治疗，但任何血管神经外科医生都应该知道如何处理颅内动脉瘤的 IOR，因为它必然会发生。本研究旨在评估颅内动脉瘤夹闭术中 IOR 的发生率和相关因素，分析此类病例中控制出血的策略，并评估结果。作者在 26 年的职业生涯中，共回顾了 911 例颅内动脉瘤病例，这些病例均通过手术治疗。在夹闭未破裂的颅内动脉瘤（65 例）时从未发现 IOR，但在 846 例蛛网膜下腔出血（SAH）病例中有 49 例（5.8%）发现了这种并发症。这种并发症最常发生在颈内动脉动脉瘤（22 例；45%），其次是前交通动脉动脉瘤（12 例；24%）、大脑前动脉远端动脉瘤（6 例；12%）、大脑中动脉动脉瘤（6 例；12%）和后循环动脉瘤（3 例；6%）。IOR 大多发生在卒中后早期手术（3 天内）（26 例；53%），最常发生在动脉瘤解剖过程中（26 例；53%）。总的来说，22 例患者（45%）预后良好，18 例（37%）有不同程度的发病率，9 例（18%）死亡。只有在大或多叶颈内动脉动脉瘤中才会出现 IOR 的致命后果。详细规划手术过程、应用精细的显微解剖技术、并在介入夹闭颅内动脉瘤时预期可能发生的术中事件，可以降低 IOR 的风险以及相关的发病率和死亡率。
