Reasons and management strategies for re-rupture during clipping of ruptured intracranial aneurysms
10.3760/cma.j.cn115354-20220815-00562
- VernacularTitle:颅内破裂动脉瘤夹闭术中再破裂原因及处理要点分析
- Author:
Yongtao GAO
1
;
Xiaobing CHEN
;
Junfeng HUO
;
Shuanglei GUO
;
Peng ZHANG
Author Information
1. 河南大学淮河医院神经外科，开封 475000
- Keywords:
Intracranial aneurysm;
Ruptured aneurysm;
Re-rupture;
Craniotomy and clipping
- From:
Chinese Journal of Neuromedicine
2022;21(11):1127-1132
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the reasons and management strategies for re-rupture during clipping of ruptured intracranial aneurysms.Methods:Twenty-one patients with ruptured intracranial aneurysms, accepted clipping by micro-craniotomy in Department of Neurosurgery, Huaihe Hospital of Henan University from May 2015 to October 2021, were chosen in our study. All patients suffered re-rupture at different intraoperative stages. The clinical characteristics, aneurysm parameters, prognoses and complications were retrospectively analyzed. Combined with the relevant literature, the causes and essential treatments for re-rupture at different intraoperative stages were summarized.Results:The average age of these 21 patients was 65 years. All patients were accompanied by disturbance of consciousness at admission. Hunt-Hess grading III was noted in 16 patients and Hunt-Hess grading IV in 5. Anterior communicating artery aneurysms were noted in 12 patients, posterior communicating artery aneurysms in 6, and middle cerebral artery aneurysms in 3; multiple saccular aneurysms were noted in 12 patients and irregular aneurysms in 4; large aneurysms were noted in 18 patients and giant aneurysms in 3. Among the 3 patients with re-rupture at the early stage of clipping (before aneurysm separation), 2 were died and 1 was severely disabled; among the 14 patients with re-rupture at the middle stage of clipping (during separation of aneurysm from its parent artery), 3 had cerebral infarction and 3 had severe disability after surgery; among the 4 patients with re-rupture at the late stage of clipping (after clipping of the aneurysm neck), 2 had cerebral infarction and 2 had severe disability.Conclusion:Patients would trend to have re-rupture during clipping of ruptured intracranial aneurysms in cases that patients have older age, severe diseases and special parameters (locations, shapes, volumes) of the aneurysms, surgeries are operated by inexperienced operator, or surgeries have improper intraoperative operations; during any period of the surgery, the separation and clamping should be fine and gentle to avoid excessive traction.
