Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations

Objective. to assess the frequency, risk factors and clinical and neurological consequences of intraoperative rupture of arterial aneurysm (AA) of the brain (B) in clipping operations of the B AA . Materials and approaches. A retrospective analysis of microsurgical operations clipping of cerebra...

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Main Authors: Bindu A. V., Orlov M. Yu., Litvak S. O., M. V. Yeleynik
Format: Article
Language:English
Published: London Academic Publishing 2020-03-01
Series:Romanian Neurosurgery
Subjects:
Online Access:https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1341
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spelling doaj-6630c1a4599547099d068009f8e30c9d2020-11-25T03:32:10ZengLondon Academic PublishingRomanian Neurosurgery1220-88412344-49592020-03-01341Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operationsBindu A. V.Orlov M. Yu.Litvak S. O.M. V. Yeleynik Objective. to assess the frequency, risk factors and clinical and neurological consequences of intraoperative rupture of arterial aneurysm (AA) of the brain (B) in clipping operations of the B AA . Materials and approaches. A retrospective analysis of microsurgical operations clipping of cerebral aneurysms in 1449 (100%) patients for the period from 2011 to 2018 was performed, of which 141 (9.73%) cases had intraoperative rupture of the aneurysm (IORA). Preoperative examination: clinical and neurological examination, CT of the brain, cerebral angiography( CAG), duplex scanning of the main vessels of the head and neck. The analyzed criteria are risk factors of IORA: AA size, localization, shape, duration of surgery after the primary rupture of AA, the presence of hypertension and the patient's condition before surgery. Results. The frequency of IORA in clipping operations of B AA was 9.73% (141 patients) in a series of observations 1441 (100%). Most often IORA-141 (100%) was registered in clipping operations of AA of complex ACA-AcomA (86 (61%) cases out of 141 (100%)). IORA is possible at all stages of the operation with the maximum frequency of contact breaks – 135 (95.74%); the rarest-6 ( 4.26%)  -  non - contact IORA (at the stage of craniotomy)  was recorded. At the preoperative stage, the vast majority of patients with subsequent IORA were diagnosed with cerebral edema, AA of large size, atherosclerotic changes in the aneurysm-affected segment of the artery and cervical areas of the aneurysm, high blood pressure during surgery, adhesive arachnoid changes. At the time of discharge from the hospital, according to the Glasgow results scale: 69 (48.94%) full or partial restoration of labor activity, 18 (12.77%) had limited daily activities without the need for outside assistance, 37 (26 24%) deep disability ) Deaths were in the group of "contact" IORA -  17 (12.06%). At 6 ( 4.26%) of "non-contact" IORA,  a deepening of initial neurological symptoms was recorded with a suppression of the level of consciousness, the addition of pyramidal insufficiency, speech impairment and psycho-organic syndrome, and a deepening of the phenomena of initial cerebral arterial vasospasm. Conclusions. IORA is predominantly in contact with a frequency of occurrence-9.73 %. The most common risk factors for IORA were: cerebral edema, large AA, atherosclerotic changes in the aneurysm-affected artery segment and cervical aneurysm sites, high blood pressure during surgery, adhesions arachnoid changes. IORA leads to deepening of initial neurological symptoms, phenomena of initial vasospasm of cerebral arteries with the level of total mortality-17 (12.06%). https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1341AA-arterial aneurysmIOC-intraoperative complicationsSAH-subarachnoid haemorrhageIORA-intraoperative rupture of aneurysm
collection DOAJ
language English
format Article
sources DOAJ
author Bindu A. V.
Orlov M. Yu.
Litvak S. O.
M. V. Yeleynik
spellingShingle Bindu A. V.
Orlov M. Yu.
Litvak S. O.
M. V. Yeleynik
Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations
Romanian Neurosurgery
AA-arterial aneurysm
IOC-intraoperative complications
SAH-subarachnoid haemorrhage
IORA-intraoperative rupture of aneurysm
author_facet Bindu A. V.
Orlov M. Yu.
Litvak S. O.
M. V. Yeleynik
author_sort Bindu A. V.
title Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations
title_short Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations
title_full Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations
title_fullStr Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations
title_full_unstemmed Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations
title_sort risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations
publisher London Academic Publishing
series Romanian Neurosurgery
issn 1220-8841
2344-4959
publishDate 2020-03-01
description Objective. to assess the frequency, risk factors and clinical and neurological consequences of intraoperative rupture of arterial aneurysm (AA) of the brain (B) in clipping operations of the B AA . Materials and approaches. A retrospective analysis of microsurgical operations clipping of cerebral aneurysms in 1449 (100%) patients for the period from 2011 to 2018 was performed, of which 141 (9.73%) cases had intraoperative rupture of the aneurysm (IORA). Preoperative examination: clinical and neurological examination, CT of the brain, cerebral angiography( CAG), duplex scanning of the main vessels of the head and neck. The analyzed criteria are risk factors of IORA: AA size, localization, shape, duration of surgery after the primary rupture of AA, the presence of hypertension and the patient's condition before surgery. Results. The frequency of IORA in clipping operations of B AA was 9.73% (141 patients) in a series of observations 1441 (100%). Most often IORA-141 (100%) was registered in clipping operations of AA of complex ACA-AcomA (86 (61%) cases out of 141 (100%)). IORA is possible at all stages of the operation with the maximum frequency of contact breaks – 135 (95.74%); the rarest-6 ( 4.26%)  -  non - contact IORA (at the stage of craniotomy)  was recorded. At the preoperative stage, the vast majority of patients with subsequent IORA were diagnosed with cerebral edema, AA of large size, atherosclerotic changes in the aneurysm-affected segment of the artery and cervical areas of the aneurysm, high blood pressure during surgery, adhesive arachnoid changes. At the time of discharge from the hospital, according to the Glasgow results scale: 69 (48.94%) full or partial restoration of labor activity, 18 (12.77%) had limited daily activities without the need for outside assistance, 37 (26 24%) deep disability ) Deaths were in the group of "contact" IORA -  17 (12.06%). At 6 ( 4.26%) of "non-contact" IORA,  a deepening of initial neurological symptoms was recorded with a suppression of the level of consciousness, the addition of pyramidal insufficiency, speech impairment and psycho-organic syndrome, and a deepening of the phenomena of initial cerebral arterial vasospasm. Conclusions. IORA is predominantly in contact with a frequency of occurrence-9.73 %. The most common risk factors for IORA were: cerebral edema, large AA, atherosclerotic changes in the aneurysm-affected artery segment and cervical aneurysm sites, high blood pressure during surgery, adhesions arachnoid changes. IORA leads to deepening of initial neurological symptoms, phenomena of initial vasospasm of cerebral arteries with the level of total mortality-17 (12.06%).
topic AA-arterial aneurysm
IOC-intraoperative complications
SAH-subarachnoid haemorrhage
IORA-intraoperative rupture of aneurysm
url https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1341
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