Preventive and emergent management of intraoperative rupture of anterior circulation intracranial aneurysms

Objective To study the causes,preventive methods and emergent management of anterior circulation aneurysmal rupture during operation. Methods The clinical materials and surgical procedures of 16 intraoperative aneurysmal ruptured patients within the latest one and half year were analysed retrospectively,and relative literatures were reviewed,in order to include helpful treatment experiences. Results The aneurysm ruptures occurred in 6,6,4 patients respectively during induction of anesthesia and craniotomy,exposure of parent artery and severing of aneurysms,clipping aneurysms. Successfully reclippings of aneurysms were obtained in 11 patients,isolation of aneurysms in 3 patients,no clipping in 2 patients. 3 patients were dead and 7 patients suffered from nervous system complications. Prognosis is satisfied by long term follow-up results. Conclusion The improper surgical methods may increase the opportunity of premature aneurysmal rupture during operation; acute encephalocele after rupture and secondary injury due to blinded surgical management may influence surgical effects directly. Intracranial aneurysmal rupture during clip operations may be impossibly avoided,to pay attention to preventive methods and reasonable usage of emergent managements may decrease incidence of rupture and improve prognosis.