gms | German Medical Science

Objective: To assess risk factors for intraoperative aneurysm rupture (ioAR) during surgical clipping after aneurysmal subarachnoid hemorrhage (SAH).

Method: Between January 2008 and October 2012 one hundred patients underwent surgical clipping after suffering SAH at our institution and data were evaluated retrospectively. Demographic data as well as aneurysm location, timing of surgery, preoperative severity grades (Hunt and Hess, Fisher, WFNS), and presence of intraparenchymal hemorrhage (ICH) on preoperative CT scans were analyzed. Surgical technique was reviewed using intraoperative video tapes.

Results: Out of 100 patients (38 m, 62 f) with a median age of 56.78 years (23 - 85) ioAR occurred in 34 cases (34%). Severe cases were overrepresented in our series: 56 patients had a Fisher grade of 4 and 36 had a Fisher grade of 3. When comparing the group of unruptured cases (n=66) to the group with ioAR (n=34), severity grades were significantly higher in the ruptured group (Fisher p=0.001; Hunt and Hess p=0.001; WFNS=0.023) and ICH was associated with intraoperative rupture (p=0.002). In 27 of the ioAR cases (79.41%) patients had a Fisher grade of 4. No significant differences were seen regarding age, sex, aneurysm location and timing of surgery.

Conclusions: ICH and a Fisher grade of 4 were significant preoperative risk factors of ioAR. There was no significant association between intraoperative rupture and timing of surgery.