Abstract
Intraoperative aneurysmal rupture must be the most serious and stressful complication encountered in clipping surgery. Since the inappropriate management of this complication may lead to catastrophic results, it is required that surgeons acquire adequate skills and knowledge for handling intraoperative ruptures. First of all, excitement and haste seem to be the major causes of subsequent disaster. An excited mental state may cause finger tremor, and sometimes the surgeons may lose his cool judgment. An impatient surgeon will tend to use large and strong suction to aspirate the splashing blood promptly, which sometimes causes additional damage to the surounding tissue or even the avulsion of veins or perforators leading to catastrophic multiple bleeding. Such mental instability in the surgeon is mainly caused by anxiety that the encountered massive hemorrhage will ultimately lead to the patient's death. However, the rupture of a cerebral aneurysm is essentially the bleeding from the peripheral artery, and the loss of blood volume is usually not so massive as imagined. Thus, the surgeon should place the appropriate size suction tip to the pool of blood in a cool manner, being careful not to damage the surrounding tissue and therapy leading to additional bleeding points. When the bleeding point is securely observed, the temporary hemostasis should be obtained using a tentative clip. If exposure of the operative field is inadequate, the use of a temporary clip may also be another option of choice. After temporary hemostasis is obtained, the routine dissection is contined place the final clip to the appropriate position. In conclusion, meticulous observation of the bleeding point without haste is a shorter way to a favorable outcome, even in intraoperative rupture of cerebral aneurysms.
