Predictors and Treatment Strategies of Intraprocedural Rupture in Intracranial Aneurysms: A Single-Center Experience with 2302 Patients

Abstract

Objective: Intraoperative rupture of an aneurysm is a known risk in the surgical management of intracranial aneurysms. The aim of the present study is to determine the risk factors for IPR.Methods: This study retrospectively examined 2302 patients with intracranial aneurysms treated surgically between December 1996 and July 2019. These patients were categorized into two groups according to whether they exhibited IPR or not: i) The non-IPR group; and ii) the IPR group. Multiple factors, including sex, age, history of SAH, Hunt-Hess grade, Fisher score, operation timing, surgical approach, GOS, size, side, site, number, orientation, morphology and adhesion to surrounding tissue, were analyzed to identify factors associated with IPR.Results: The overall rupture rate was 14.8%. Overall, the number of SAHs (1, ≥2) and aneurysm location (supraclinoid ICA and PICA) were found to be independent risk factors for IPR. This analysis revealed that in the MCA aneurysm database the risk for IPR decreased in patients aged >40 years. Furthermore, the present study identified a progressive increase in the risk of IPR with increasing H-H grade. Finally, in the ACOA aneurysm database the left pterional and coronal craniotomy approach increased the risk for IPR up to 1.99- and 15.153-fold, respectively, compared with the right pterional approach.Conclusions: The number of SAHs (1, ≥2) and aneurysms site (supraclinoid ICA and PICA), age ≤40 years, higher H-H grade and surgical approach (left pterional and coronal craniotomy) seem to be important factors affecting the incidence of IPR.