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Analysis of the relationship between different bleeding positions on intraoperative rupture anterior circulation aneurysm and surgical treatment outcome

  • Clinical Article - Vascular
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Abstract

Background

It is well recognized that intraoperative aneurysm rupture (IAR) is a serious event that is difficult to manage and has a relatively serious influence on a patient’s prognosis. The aim of this study was to evaluate the prognostic value of different bleeding positions of IAR in patients, and to describe the technique that the authors have used to clip the ruptured aneurysms.

Methods

From May 2009 to March 2012, a total of 148 aneurysms in 135 consecutive patients in our institution underwent clipping surgeries, and 31 IARs occurred in 30 patients. The clinical data of all patients were retrospectively analyzed. Statistics analysis was performed to analyze possible factors of different bleeding positions of IARs, to assist observation.

Results

Outcome was estimated by Glasgow outcome scale via following up or calling back within 1, 3, and 6 months after surgery: 94 patients were 5’, 23 patients were 4’, nine patients were 3’, two patients were 2’ and eight patients were 1’. There was no significant difference between the outcome of IAR and that of no intraoperative aneurysm rupture (NIAR) in Hunt–Hess groups 0–III (P = 0.802) and Hunt–Hess groups IV–V (P = 0.229), and the different bleeding positions were shown to be an important factor that significantly influences the patients’ prognosis (P = 0.001).

Conclusions

Different bleeding positions of IAR have a significant impact on surgical outcome; IAR of the neck is the most devastating complication. If surgeons take appropriate measures according to different bleeding positions, the efficiency, accuracy and security of the operation will be improved.

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Abbreviations

IAR:

Intraoperative aneurysm rupture

NIAR:

No intraoperative aneurysm rupture

DSA:

Digital subtraction angiography

CT:

Computer tomography

CTA:

Computer tomography angiography

ACoAA:

Anterior communication artery aneurysm

PCoAA:

Posterior communicating artery aneurysm

MCAA:

Middle cerebral artery aneurysm

ACAA:

Anterior circulation arteries aneurysm

ICAA:

Internal carotid artery aneurysm

GOS:

Glasgow outcome scale

VIB:

Volume of intraoperative blood loss

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Acknowledgments

YKX, ZY, ZHZ and ZSK performed the majority of this study and wrote the manuscript; ZHZ, XY, HL and SLH provided the material of the patients from the database. All authors have read and approved the content.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Su Bei People’s Hospital of Jiangsu Province, Yangzhou University, No. 98 West Road of Nantong, 225001, Yangzhou city, Jiangsu Province, China

    Yong Zhen, Kaixuan Yan, Hengzhu Zhang, Shaokun Zhao, Yao Xu, Hengzhong Zhang, Liang He & Linhai Shen

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  1. Yong Zhen
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  2. Kaixuan Yan
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  3. Hengzhu Zhang
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  4. Shaokun Zhao
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Correspondence to Kaixuan Yan.

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Zhen, Y., Yan, K., Zhang, H. et al. Analysis of the relationship between different bleeding positions on intraoperative rupture anterior circulation aneurysm and surgical treatment outcome. Acta Neurochir 156, 481–491 (2014). https://doi.org/10.1007/s00701-013-1953-0

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  • DOI: https://doi.org/10.1007/s00701-013-1953-0

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