Clipping of cerebral aneurysm complicated by intraoperative rupture
Keywords:arterial aneurysm, intraoperative aneurysm rupture, arteria cerebral media, intraoperative complications, dura mater
Despite the development of neurosurgical treatment of brain aneurysm (BA), the problem of intraoperative aneurysm rupture (IAR) remains relevant. The IAR is the most common intraoperative complication, which, according to various authors, occurs in 5.6–35.0 % cases. There are contact and non-contact IAR. Noncontact are those that occur at the early stages of the operation, before the dissection of dura mater, when there is no mechanical effect on the aneurysm. Noncontact IAR accounts for 2.5–9.0 % of the total amount of IAR. Contact IAR occurs in 91–94 % of observations. IAR occurs predominantly in arachnoid dissection (48–81 %). The main criteria and risk factors for the IAR are the size of BA, its localization, the operation duration after the initial rupture of BA, the presence of hypertension and the severity of the patient’s condition before surgery. The greatest risk of IAR is predisposed by aneurysms of the anterior communicating artery complex — an anterior cerebral artery and internal carotid artery. Performing surgery at the early stages after aneurysm rupture in the presence of cerebral edema along with the difficult access to BA and with the need to perform sufficient traction of the brain substance is more often accompanied by IAR.
IAR results in deterioration of the results of operations and an increase in mortality by 1.5–3.0 times. The prognosis of survival of patients after IAR at the stages of aneurysm isolation and clipping is more favourable than at the initial stages of surgery.
4. Lin TK, Hsieh TC, Tsai HC, Lu YJ, Lin CL, Huang YC. Factors associated with poor outcome in patients with major intraoperative rupture of intracranial aneurysm. Acta Neurol Taiwan. 2013 Sep;22(3):106-11. [PubMed]
5. Acciarri N, Toniato G, Raabe A, Lanzino G. Clipping techniques in cerebral aneurysm surgery. J Neurosurg Sci. 2016 Mar;60(1):83-94. [PubMed]
7. Liu Q, Jiang P, Wu J, Gao B, Wang S. The Morphological and Hemodynamic Characteristics of the Intraoperative Ruptured Aneurysm. Front Neurosci. 2019 Mar 26;13:233. [CrossRef] [PubMed] [PubMed Central]
8. Tian Z, Zhang Y, Jing L, Liu J, Zhang Y, Yang X. Rupture Risk Assessment for Mirror Aneurysms with Different Outcomes in the Same Patient. Front Neurol. 2016 Dec 5;7:219. [CrossRef] [PubMed] [PubMed Central]
10. Dzyak LA, Zorin NA, Golik VA, Skrabets Yu. [Arterial aneurysms and arteriovenous malformations of the brain]. Dnepropetrovsk: Porogi, 2003. Russian.
11. Krylov V.V., Prirodov A.V. Risk factors of surgical treatment for middle cerebral artery aneurysms in acute period of subarachnoid hemorrhage. The Russian Journal of Neurosurgery. 2011;(1):31-41. Russian. Available from: https://elibrary.ru/item.asp?id=16449822
13. Forget TR Jr, Benitez R, Veznedaroglu E, Sharan A, Mitchell W, Silva M, Rosenwasser RH. A review of size and location of ruptured intracranial aneurysms. Neurosurgery. 2001 Dec;49(6):1322-5; discussion 1325-6. [CrossRef] [PubMed]
14. Goertz L, Hamisch C, Telentschak S, Kabbasch C, von Spreckelsen N, Stavrinou P, Timmer M, Goldbrunner R, Brinker G, Krischek B. Impact of Aneurysm Shape on Intraoperative Rupture During Clipping of Ruptured Intracranial Aneurysms. World Neurosurg. 2018 Oct;118:e806-e812. [CrossRef] [PubMed]
15. Kheireddin AS, Filatov IuM, Belousova OB, Pilipenko IuV, Zolotukhin SP, Sazonov IA, Zarzur KhKh. [Intraoperative rupture of cerebral aneurysm--incidence and risk factors]. Zh Vopr Neirokhir Im N N Burdenko. 2007 Oct-Dec;(4):33-8; discussion 38. Russian. [PubMed]
16. Kopitnik TA, Horowitz MB, Samson DS. Surgical management of intraoperative aneurysm rupture. In: Schmidek HH, Sweet WH, editors. Schmidek & Sweet’s Operative Neurosurgical Techniques: Indications, Methods, and Results. 4th ed. Philadelphia: WB Saunders Co; 2000. p. 1275–1281.
17. Chen SF, Kato Y, Kumar A, Tan GW, Oguri D, Oda J, Watabe T, Imizu S, Sano H, Wang ZX. Intraoperative rupture in the surgical treatment of patients with intracranial aneurysms. J Clin Neurosci. 2016 Dec;34:63-69. [CrossRef] [PubMed]
18. Zhen Y, Yan K, Zhang H, Zhao S, Xu Y, Zhang H, He L, Shen L. Analysis of the relationship between different bleeding positions on intraoperative rupture anterior circulation aneurysm and surgical treatment outcome. Acta Neurochir (Wien). 2014 Mar;156(3):481-91. [CrossRef] [PubMed]
19. Della Puppa A, Rossetto M, Volpin F, Rustemi O, Grego A, Gerardi A, Ortolan R, Causin F, Munari M, Scienza R. Microsurgical Clipping of Intracranial Aneurysms Assisted by Neurophysiological Monitoring, Microvascular Flow Probe, and ICG-VA: Outcomes and Intraoperative Data on a Multimodal Strategy. World Neurosurg. 2018 May;113:e336-e344. [CrossRef] [PubMed]
20. Liu Q, Jiang P, Wu J, Li M, Gao B, Zhang Y, Ning B, Cao Y, Wang S. Intracranial aneurysm rupture score may correlate to the risk of rebleeding before treatment of ruptured intracranial aneurysms. Neurol Sci. 2019 Aug;40(8):1683-1693. [CrossRef] [PubMed]
22. Fridriksson S, Säveland H, Jakobsson KE, Edner G, Zygmunt S, Brandt L, Hillman J. Intraoperative complications in aneurysm surgery: a prospective national study. J Neurosurg. 2002 Mar;96(3):515-22. [CrossRef] [PubMed]
23. Horiuchi T, Tsutsumi K, Ito K, Hongo K. Results of clipping surgery for aneurysmal subarachnoid hemorrhage in the ninth and tenth decades of life. J Clin Neurosci. 2014 Sep;21(9):1567-9. [CrossRef] [PubMed]
24. Acioly MA, Shaikh KA, White IK, Ziemba-Davis M, Bohnstedt BN, Cohen-Gadol A. Predictors of Outcomes and Complications After Microsurgical and Endovascular Treatment of 1300 Intracranial Aneurysms. World Neurosurg. 2019 Feb;122:e516-e529. [CrossRef] [PubMed]
25. Darkwah Oppong M, Pierscianek D, Ahmadipour Y, Dinger TF, Dammann P, Wrede KH, Özkan N, Müller O, Sure U, Jabbarli R. Intraoperative Aneurysm Rupture During Microsurgical Clipping: Risk Re-evaluation in the Post-International Subarachnoid Aneurysm Trial Era. World Neurosurg. 2018 Nov;119:e349-e356. [CrossRef] [PubMed]
26. Sandalcioglu IE, Schoch B, Regel JP, Wanke I, Gasser T, Forsting M, Stolke D, Wiedemayer H. Does intraoperative aneurysm rupture influence outcome? Analysis of 169 patients. Clin Neurol Neurosurg. 2004 Mar;106(2):88-92. [CrossRef] [PubMed]
28. Fushihara G, Kamide T, Kimura T, Takeda R, Ikeda T, Kikkawa Y, Araki R, Kurita H. Factors associated with early seizures after surgery of unruptured intracranial aneurysms. Clin Neurol Neurosurg. 2019 Mar;178:93-96. [CrossRef] [PubMed]
29. Frösen J, Tulamo R, Paetau A, Laaksamo E, Korja M, Laakso A, Niemelä M, Hernesniemi J. Saccular intracranial aneurysm: pathology and mechanisms. Acta Neuropathol. 2012 Jun;123(6):773-86. [CrossRef] [PubMed]
31. Boogaarts HD, van Lieshout JH, van Amerongen MJ, de Vries J, Verbeek AL, Grotenhuis JA, Westert GP, Bartels RH. Aneurysm diameter as a risk factor for pretreatment rebleeding: a meta-analysis. J Neurosurg. 2015 Apr;122(4):921-8. [CrossRef] [PubMed]
32. Krylov VV, Evzikov GIu, Saribekian AS, Rurua VG, Shelkovskiĭ VN, Karamyshev RA, Gel’fenbeĭn MS. [Intraoperative hemorrhages during the surgical treatment of aneurysms of the cerebral vessels]. Zh Vopr Neirokhir Im N N Burdenko. 1996 Apr-Jun;(2):3-6. Russian. [PubMed]
33. Gaydar BV, editor. [Practical Neurosurgery: A Guide for Physicians]. St. Petersburg: Gippokrat; 2002. Russian.
34. Krylov VV, editor. [Surgery of cerebral aneurysms]. Volume 2. Moscow, 2011. Russian.
35. Jou LD, Lee DH, Morsi H, Mawad ME. Wall shear stress on ruptured and unruptured intracranial aneurysms at the internal carotid artery. AJNR Am J Neuroradiol. 2008 Oct;29(9):1761-7. [CrossRef] [PubMed]
36. Otani N, Wada K, Toyooka T, Takeuchi S, Tomiyama A, Mori K. Surgical Strategies for Ruptured Complex Aneurysms Using Skull Base Technique and Revascularization Surgeries. Asian J Neurosurg. 2018 Oct-Dec;13(4):1165-1170. [CrossRef] [PubMed] [PubMed Central]
37. Fukuda H, Iwasaki K, Murao K, Yamagata S, Lo BW, Macdonald RL. Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms. Surg Neurol Int. 2014 Jul 11;5:106. [CrossRef] [PubMed] [PubMed Central]
38. Chen XL, Chen Y, Ma L, Burkhardt JK, Wardell T, Wang C, Guo G, Wang S, Zhao YL. Translucent Appearance of Middle Cerebral Artery Bifurcation Aneurysms Is Risk Factor for Intraoperative Aneurysm Rupture During Clipping. World Neurosurg. 2017 May;101:149-154. [CrossRef] [PubMed]
39. Andrade GC, Braga FM. [Intraoperative rupture in the aneurysmal neck: suggestion for surgical management]. Arq Neuropsiquiatr. 2002 Sep;60(3-A):666-9. Portuguese. [PubMed]
40. Darkwah Oppong M, Pierscianek D, Ahmadipour Y, Dinger TF, Dammann P, Wrede KH, Özkan N, Müller O, Sure U, Jabbarli R. Intraoperative Aneurysm Rupture During Microsurgical Clipping: Risk Re-evaluation in the Post-International Subarachnoid Aneurysm Trial Era. World Neurosurg. 2018 Nov;119:e349-e356. [CrossRef] [PubMed]
41. Senko I, Shatokhin A, Bishnoi I, Yamada Y, Tanaka R, Suyama D, Kawase T, Kato Y. Intraoperative Rupture Cerebral Aneurysm and Computational Flow Dynamics. Asian J Neurosurg. 2018 Apr-Jun;13(2):496-498. [CrossRef] [PubMed] [PubMed Central]
42. Kashkoush AI, Jankowitz BT, Nguyen C, Gardner PA, Wecht DA, Friedlander RM, Chang YF, Habeych M, Crammond D, Balzer J, Thirumala PD. Perioperative stroke after cerebral aneurysm clipping: Risk factors and postoperative impact. J Clin Neurosci. 2017 Oct;44:188-195. [CrossRef] [PubMed]
43. Tsarenko SV, Krylov VV, Vakhnitskaya VV. The principles of intensive therapy in non-traumatic subarachnoid hemorrhages. The Russian Journal of Neurosurgery. 2003;(2):42-5. Russian. Available from: https://elibrary.ru/item.asp?id=17744777
44. Asaturian GA, Semeniutin VB, Maslennikova LS, Panutsev VS, Sergienko SK. [Temporary clipping and cerebral blood flow in patients with cerebral aneurysms]. Zh Vopr Neirokhir Im N N Burdenko. 2006 Jul-Sep;(3):18-21; discussion 21-3. Russian. [PubMed]
45. Akyuz M, Erylmaz M, Ozdemir C, Goksu E, Ucar T, Tuncer R. Effect of temporary clipping on frontal lobe functions in patients with ruptured aneurysm of the anterior communicating artery. Acta Neurol Scand. 2005 Nov;112(5):293-7. [CrossRef] [PubMed]
46. He L, Griessenauer CJ, Fusco MR, Chua MH, Stapleton CJ, Guidal BT, Thomas AJ, Ogilvy CS. Lazic Aneurysm Clip System for Microsurgical Clipping of Cerebral Aneurysms: Transition to a New Aneurysm Clip System in an Established Cerebrovascular Practice. World Neurosurg. 2016 Dec;96:454-459. [CrossRef] [PubMed]
47. Haskó G, Linden J, Cronstein B, Pacher P. Adenosine receptors: therapeutic aspects for inflammatory and immune diseases. Nat Rev Drug Discov. 2008 Sep;7(9):759-70. [CrossRef] [PubMed] [PubMed Central]
48. Lilly LS. Pathophysiology of heart disease: A collaborative project of medical students and faculty. Harvard Medical School, 2011.
49. Groff MW, Adams DC, Kahn RA, Kumbar UM, Yang BY, Bederson JB. Adenosine-induced transient asystole for management of a basilar artery aneurysm. Case report. J Neurosurg. 1999 Oct;91(4):687-90. [CrossRef] [PubMed]
50. Guinn NR, McDonagh DL, Borel CO, Wright DR, Zomorodi AR, Powers CJ, Warner DS, Lam AM, Britz GW. Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective. J Neurosurg Anesthesiol. 2011 Jan;23(1):35-40. [CrossRef] [PubMed]
51. Jeon IC, Chang CH, Choi BY, Kim MS, Kim SW, Kim SH. Cardiac troponin I elevation in patients with aneurysmal subarachnoid hemorrhage. Journal of Korean Neurosurgical Society. 2009 Aug;46;(2):99. [CrossRef]
52. Mashaly HA, Provencio JJ. Inflammation as a link between brain injury and heart damage: the model of subarachnoid hemorrhage. Cleveland Clinic Journal of Medicine. 2008 Mar 1;75(Suppl_2):S26–S30. https://www.mdedge.com/ccjm/article/94966/inflammation-link-between-brain-injury-and-heart-damage-model-subarachnoid
55. Konczalla J, Platz J, Fichtlscherer S, Mutlak H, Strouhal U, Seifert V. Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trial. J Neurosurg. 2018 Jun;128(6):1741-1752. [CrossRef] [PubMed]
56. Al-Majed NS, McAlister FA, Bakal JA, Ezekowitz JA. Meta-analysis: cardiac resynchronization therapy for patients with less symptomatic heart failure. Ann Intern Med. 2011 Mar 15;154(6):401-12. [CrossRef] [PubMed]
57. Steiger HJ, Ito S, Schmid-Elsässer R, Uhl E. M2/M2 side-to-side rescue anastomosis for accidental M2 trunk occlusion during middle cerebral artery aneurysm clipping: technical note. Neurosurgery. 2001 Sep;49(3):743-7; discussion 747-8. [CrossRef] [PubMed]
58. Ogilvy CS, Carter BS, Kaplan S, Rich C, Crowell RM. Temporary vessel occlusion for aneurysm surgery: risk factors for stroke in patients protected by induced hypothermia and hypertension and intravenous mannitol administration. J Neurosurg. 1996 May;84(5):785-91. [CrossRef] [PubMed]
59. Kett-White R, Hutchinson PJ, al-Rawi PG, Gupta AK, O’Connell MT, Pickard JD, Kirkpatrick PJ. Extracellular lactate/pyruvate and glutamate changes in patients during per-operative episodes of cerebral ischaemia. Acta Neurochir Suppl. 2002;81:363-5. [CrossRef] [PubMed]
How to Cite
Copyright (c) 2019 Artur V. Byndiu, Mikhail Y. Orlov, Maksim V. Yeleynik, Svetlana O. Lytvak
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.