Operative techniques for intracranial aneurysms, forecast and management of intraoperative aneurysm rupture

Objective To discuss the techniques of microsurgical treatment for intracranial aneurysms, analyze the characters of intraoperative aneurysm rupture by DSA/3D-DSA imaging and its managements. Methods There were 42 cases of intracranial aneurysms including 18 males and 24 females with an average of 47 years old. A total of 41 cases were performed neck clipping via pterional approach, while 1 case of giant aneurysm located at P 2 segment of posterior cerebral artery was resected after proximal parent artery was clipped with subtemporal approach.Results A total of 39 cases showed favorable outcomes, 2 cases presented hemiplegia, and 1 case was dead because of multiple cerebral infarction after operation. Intraoperative aneurysm rupture rate was 16.7% (7 out of 42 patients). For the patients of aneurysm rupture, 6 cases obtained favorable outcomes after clipping and 1 case was dead. Conclusion Delicate microsurgical procedure is the key for the management of neck clipping and avoiding intraoperative aneurysm rupture. For the aneurysms with calabash shape, broad neck or other small vesicles (daughter sacs) on DSA/3D-DSA imaging, much attention should be paid to the intraoperative aneurysm rupture.