Abstract
We present an option for controlling the intraoperative premature rupture during an acute aneurysm surgery. The patient is a 47-year-old female who suffered severe headache and soon became comatose. A CT scan on admission revealed massive hematoma in the right sylvian fissure and temporal lobe as well as severe subarachnoid hemorrhage. Angiograms showed a small aneurysm at the ophthalmic segment of the right internal carotid artery. Emergency surgery was performed. At surgery, before the internal carotid artery and the aneurysm were fully dissected, premature rupture occurred. The internal carotid artery was temporarily clipped and the bleeding point was identified. A small piece of cotton was placed on the ruptured point and pressed with a tapered brain retractor, which was connected with the self-retaining retractor, to control the bleeding. Dissection around the aneurysm was carried out with the internal carotid artery to be patent. After the aneurysm and the internal carotid artery were fully exposed, the retractor was released after temporary clips were placed on the internal carotid artery again. Then the aneurysm with ruptured site was wrapped because the aneurysm was so small.
This method, which we call “reverse compression method,” is a useful option for controlling the intraoperative premature rupture of the aneurysm or bleeding from the parent artery, although it is not always applicable.
