Intraoperative complications in aneurysm surgery: a prospective national study

Abstract

The results obtained in this series closely reflect the overall management results of this disease and support the conclusion that surgical complications causing a poor outcome can be estimated on a large population-based scale. Intraoperative aneurysm rupture was the most common and most devastating technical complication that occurred. Support was found for a more liberal use of temporary clips early during dissection, regardless of the experience of the surgeon. Temporary regional interruption of arterial blood flow should be a routine method for aneurysm surgery on an everyday basis. A random occurrence of difficult intraoperative problems was clearly shown, and this factor of unpredictability, which is present in any preoperative assessment of risk, strengthens the case for recommending neuroprotection as a routine adjunct to virtually every aneurysm operation, regardless of the surgeon's experience.

Impact of Cardio-Pulmonary and Intraoperative Factors on Occurrence of Cerebral Infarction After Early Surgical Repair of the Ruptured Cerebral Aneurysms

“…hours), intraoperative problems still occur and contribute to the poor outcome in 6% of patients 6) . The purpose of this study is to identify the individual prognostic factors that may affect the development of postoperative cerebral infarction with special emphases on surgeryrelated and anesthesia-related factors.…”

“…Temporary clipping is performed to control bleeding from an intraoperative rupture or to dissect the aneurysmal sac more safely. The general tolerance limit for temporary clipping is about 15-20 minutes because it is associated with a decrease in brain PO2 and an increase in brain PCO2, and this seems to be the critical threshold for the development of postoperative cerebral ischemic events 6,11,18) . In the current study, repeated temporary clipping was carried out if necessary, to permit sufficient interim reperfusion of cerebral blood flow for at least 5-10 minutes to prevent postoperative neurological deficits.…”

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

“…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.…”

Endovascular Treatment of Middle Cerebral Artery Aneurysms as First Option: A Single Center Experience of 92 Aneurysms

“…This is mainly because of the anatomic characteristics of these aneurysms, which often have wide necks and branches arising from the neck, and also because of their proximity to the cerebral surface, which facilitates surgical access. [2][3][4][5] The aim of this study was, therefore, to analyze retrospectively the feasibility and efficacy of ruptured and unruptured MCAA embolization in a center where this option is the first one considered.…”