Abstract
Incidence, causes and effect on surgical results of intraoperative aneurysmal rupture were analyzed in 618 consecutive cases of ruptured cerebral aneurysms. Intraoperative rupture was noted in 75 cases, an incidence of 12%. Most of the ruptures occurred during dissection of the aneurysmal neck and at neck clipping. Intraoperative aneurysmal rupture was relatively frequent in cases with anterior communicating artery, middle cerebral artery and vertebro-basilar artery aneurysms. Incidence of rupture was significantly high in cases operated on within 3 days and in cases classified into grades IV. Incidence of bleeding was not affected by the use of a temporary clip in all cases except cases with an anterior communicating artery aneurysm. Postoperative morbidity and mortality rates were 18% and 12% in cases with and without intraoperative aneurysmal rupture. This difference was not statistically significant. It may be very important in preventing intraoperative rupture and obtaining meaningful recovery of patients that active and judicious use be made of temporary clips for as short a time as possible without inducing severe hypotension.
