[The causes and strategies for intraoperative rupture during clipping the anterior circulation aneurysms].

OBJECTIVE: To investigate the causes and strategies for intraoperative rupture during clipping the anterior circulation aneurysms. METHODS: Nineteen patients with anterior circulation aneurysms ruptured during clipping, who admitted to the Department of Neurosurgery, Henan Provincial People's Hospital from November 2012 to February 2014, were enrolled. Their clinical data were analyzed retrospectively to summarize the causes and strategies for intraoperative rupture. RESULTS: The aneurysms ruptured during predissection in 2 cases (10.5%), during dissection in 11 cases (57.9%) and during clip application in 6 cases (31.6%). There was no residual aneurysm confirmed by postoperative CTA in 17 patients. One case with posterior communicating artery aneurysm cannot be clipped because of the serious avulsion of the aneurysm neck during clipping. The aneurysm was trapped and the patient paralysed on one side after operation. One case died postoperative 8 days because of severe cerebral edema, whose aneurysm ruptured during predissection. The Glasgow Outcome Scale (GOS) of three months after operation showed good recovery in 11, moderate recovery in 5, severe disability in 2, and death in 1 cases, respectively. CONCLUSION: Adequate preoperative evaluation for the risk factors of intraoperative rupture and excellent microsurgical techniques can prevent intraoperative rupture of intracranial aneurysms. Controlling the bleeding quickly and dissecting and clipping the aneurysm after definitely know the anatomy of the aneurysm and surrounding vasculature could be the keys to deal with intraoperative aneurysm rupture.