Intra-Operative Premature Rupture of the Cerebral Aneurysms. Analysis of the Causes and Management

Houkin, Kiyohiro; Kuroda, Satoshi; Takahashi, Akihiro; Takikawa, Shugo; Ishikawa, Tatsuya; Yoshimoto, Tetsuyuki; Itamato, K

doi:10.1007/s007010050428

Cited by 65 publications

(31 citation statements)

References 8 publications

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“…In surgical series of ruptured aneurysms, small size does not appear to affect the risk of intraoperative rupture, although very small aneurysms (Յ 3 mm) have not been isolated as a study group. 1,5,6 The high mortality and morbidity rates associated with procedure-related aneurysm perforation call for optimum preparation for cases considered high risk (that is, very small, ruptured aneurysms). In our series, in the event of procedure-related rupture, placement of a balloon adjacent to the aneurysm prior to coil embolization, with the intention of producing hemostasis or remodeling was associated with better outcome compared with results in patients treated without balloon assistance.…”

Section: Impact Of Balloon Assistance In Management Of Procedure-relamentioning

confidence: 99%

Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture

Nguyen

Raymond²,

Guilbert³

et al. 2008

JNS

178

145

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Object Procedure-related rupture during endovascular therapy of intracranial aneurysms is associated with a mortality rate of more than one third. Previously ruptured aneurysms are a known risk factor for procedure-related rupture. The objective of this study was to evaluate whether very small, ruptured aneurysms are associated with more frequent intraprocedural ruptures. Methods This was a retrospective cohort study in which the investigators examined consecutive ruptured aneurysms treated with coil embolization at a single institution. The study was approved by the institutional review board. Very small aneurysms were defined as ≤ 3 mm. Procedure-related rupture was defined as contrast extravasation during treatment. Univariate analysis with the Fisher exact test and the Mann–Whitney U test was performed. Results Between August 1992 and January 2007, 682 aneurysms were selectively treated with coils in 668 patients. Procedure-related rupture occurred in 7 (11.7%) of 60 aneurysms ≤ 3 mm, compared with 14 (2.3%) of 622 aneurysms > 3 mm (relative risk 5.2, 95% confidence interval 2.2–12.8; p < 0.001). Among cases with procedure-related rupture, inflation of a compliant balloon was associated with better outcome (Glasgow Outcome Scale Score ≥ 4) compared with patients treated without balloon assistance (5 of 5 compared with 7 of 16; p = 0.05). Death resulting from procedure-related rupture occurred in 8 (38%) of 21 patients, and a vegetative state occurred in 1 patient. Clinical outcome was good in the other 12 patients (57%). Conclusions Endovascular coil embolization of very small (≤ 3 mm) ruptured cerebral aneurysms is 5 times more likely to result in procedure-related rupture compared with larger aneurysms. Balloon inflation for hemostasis may be associated with better outcome in the event of intraprocedural rupture and merits further study.

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Section: Impact Of Balloon Assistance In Management Of Procedure-relamentioning

confidence: 99%

Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture

Nguyen

Raymond²,

Guilbert³

et al. 2008

JNS

178

145

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“…[8][9][10] There were significantly more patients in the group with intraoperative rerupture who presented with Hunt and Hess Grade I (p < 0.01, Fisher's exact test; Table 1). Fisher grades and modified Fisher grades between the groups were similar.…”

Section: Subarachnoid Hemorrhage Characteristicsmentioning

confidence: 99%

Intraoperative rerupture during surgical treatment of aneurysmal subarachnoid hemorrhage is not associated with an increased risk of vasospasm

Sheth¹,

Hausrath

Numis³

et al. 2014

JNS

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Object Intraoperative rerupture during open surgical clipping of cerebral aneurysms in subarachnoid hemorrhage (SAH) is a relatively frequent and potentially catastrophic occurrence. Patients who suffer rerupture have been shown to have worse outcomes at discharge compared with those who do not have rerupture. Perioperative injury likely plays a large part in the clinical worsening of these patients. However, due to the increased vessel manipulation and repeat exposure to acute hemorrhage, it is possible that secondary injury from increased incidence of vasospasm also contributes. Identifying an increased rate of vasospasm in these patients would justify early aggressive treatment with measures to prevent delayed cerebral ischemia. The authors investigated whether patients who suffer intraoperative rerupture during surgical treatment of ruptured cerebral aneurysms are at increased risk of developing vasospasm. Methods Five hundred consecutive patients treated with open surgical clipping for SAH were reviewed, and clinical and imaging data were collected. Angiographic vasospasm was defined as vessel narrowing believed to be consistent with vasospasm on angiography. Symptomatic vasospasm was defined as angiographic vasospasm in the setting of a clinical change attributable to vasospasm. Rates of angiographic and symptomatic vasospasm among patients with and without intraoperative rerupture were compared. Results There were no significant differences between the groups with and without rupture with respect to age, sex, modified Fisher grade, history of hypertension, or smoking. The group with intraoperative rupture had more patients with Hunt and Hess Grade I. Angiographic vasospasm was noted in 279 (66%) of the 425 patients without rerupture compared with 49 (65%) of the 75 patients with rerupture (p = 1.0, Fisher's exact test). Symptomatic vasospasm was noted in 154 (36%) of the 425 patients without rerupture, compared with 31 (41%) of the 75 patients with rerupture (p = 0.44, Fisher's exact test). In multivariate analysis, higher modified Fisher grade was significantly predictive of vasospasm, whereas older age and male sex were protective. Conclusions This study found no significant influence of intraoperative rerupture during open surgical clipping on the rate of angiographic or symptomatic vasospasm. Brief exposure to acute hemorrhage and vessel manipulation associated with rerupture events did not affect the rate of vasospasm. Risk of vasospasm was related to increased modified Fisher grade, and inversely related to age and male sex. These results do not justify early, targeted vasospasm therapy in patients with intraoperative rerupture.

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“…Other etiologies include intra-operative hypertension, changes in flow dynamics, traction on arachnoid bands, shift of intracranial contents during bone or dural opening as well as removal of a space occupying lesion. One study of open craniotomies for aneurysms reported 8.3% of ruptures occurred during dural and arachnoid opening, 12.5% during hematoma evacuation, 16.7% during brain retraction and 62% during aneurysm dissection [17]. The rupture in our case likely occurred due to brain shift from the resulting decompression of the sella.…”

Section: Discussionmentioning

confidence: 69%

Intra-Operative Rupture of Remote Aneurysm during Transphenoidal Resection of Pituitary Macroadenoma

Rajah¹,

Hornyak

2014

OJMN

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Rupture of intracranial aneurysm resulting in subarachnoid hemorrhage is well known to carry significant risk of poor outcome. Intra-operative rupture of an unknown intracranial aneurysm during a neurosurgical procedure is a rare occurrence that can lead to devastating consequences if not recognized and managed appropriately. Here we describe to our knowledge, the first reported case of previously unknown, remote from the surgical site, intra-operative posterior cerebral artery aneurysm rupture during transnasal endoscopic transphenoidal resection of a pituitary macroadenoma, review relevant literature, and discuss strategies to reduce surgical risk and improve patient outcomes.

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Intra-Operative Premature Rupture of the Cerebral Aneurysms. Analysis of the Causes and Management

Cited by 65 publications

References 8 publications

Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture

Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture

Intraoperative rerupture during surgical treatment of aneurysmal subarachnoid hemorrhage is not associated with an increased risk of vasospasm

Intra-Operative Rupture of Remote Aneurysm during Transphenoidal Resection of Pituitary Macroadenoma

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