gms | German Medical Science

Objective: Intraoperative aneurysm rupture is a serious complication that declines the overall prognosis of the patient and represents a challenge for the neurosurgeon. Aspects that could help to identify high risk aneurysms or predict an impending intraoperative rupture would be helpful preoperative information.

Method: In this retrospective study we evaluated 229 patients with surgically treated aneurysms of the anterior circulation. 158 presented with SAH, 38 had an intraoperative rupture. We reviewed the charts and all radiographic imaging, searching for clinical and morphological predictors of intraoperative rupture. The data were statistically calculated using uni- and multivariate analysis.

Results: All patients who had an intraoperative rupture (n=38, 24.1%) presented with SAH. Patients with intraoperative rupture had a significantly worse Hunt and Hess (HH) as well as WFNS grade (p=0.007 and 0.014 respectively). Fisher grade, however, was not significantly different (p=0.546). Patients with intraoperative rupture developed significantly more frequently a new ischemia (p=0.001) and had a worse outcome (p=0.003). Temporary clipping time and surgery time was longer in patients with intraoperative rupture (p=0.001 and 0.034 respectively). Longer temporary clipping time was associated with a higher frequency of new cerebral ischemia (p=0.022). The analysis of aneurysm morphology showed a larger dome-base in patients with intraoperative rupture (p=0.042) as well as a higher frequency of branching vessels (p=0.0071). Multiple logistic regressions revealed the HH grade as well as the initial GCS as independent prognostic factors for intraoperative rupture.

Conclusions: SAH, neurological performance (HH, WFNS) and characteristic aneurysm morphology (dome-base distance, branching vessels) are important predictors of intraoperative aneurysm rupture.