Intraoperative Aneurysmal Rupture

Yoshinori SAKATA, Hiromu HADEISHI, Michihiro TANAKA, Keisuke KADOOKA, Hiroshi SAITO, Maki INABA, Takashi IWATA, Atsushi TSUKIYAMA
2021 Surgery for Cerebral Stroke  
達手術を行った未破裂脳動脈瘤 255 例 312 動脈瘤のうち術 中破裂をきたした 8 例 (Table 1) .出血を誘発した操作に 関しては手術ビデオおよび手術記録に基づき検討した.転 帰は Glasgow Outcome Scale (GOS) を用いて評価した. 結 果 術中破裂の頻度は 255 例中 8 例,312 動脈瘤中 8 動脈瘤 で,症例あたり 3.1%,動脈瘤あたり 2.6%であった.内訳 は女性 5 例,男性 3 例で,年齢は 46-71 歳 (平均 62.1 歳) , 動脈瘤サイズは 3.4-21.0 mm (平均 7.3 mm) であり,動脈瘤は 前交通動脈瘤 (anterior communicating artery aneurysm: 術中破裂をきたした未破裂脳動脈瘤 坂田 義則,波出石 弘,田中美千裕,門岡 慶介 齋藤 浩史,稲葉 眞貴,岩田 卓士,築山 敦 Summary: Most unruptured cerebral aneurysms are asymptomatic and associated with extremely low
more » ... es of surgical complications. Therefore, the control of ruptures before clipping the aneurysmal neck should be of considerable prognostic significance. We retrospectively assessed data from 255 consecutive surgical patients with a total of 312 aneurysms treated between September 2006 and June 2019 , and selected eight aneurysms that ruptured before clipping. Of the eight intraoperative aneurysm ruptures, four (50%) were anterior communicating artery aneurysms (Acom Ans). The incidence of intraoperative aneurysm rupture was 3.1% of patients and 2.6% of aneurysms. The main contributor to aneurysm rupture was dissection around the aneurysms. The outcomes were favorable in all patients. We considered that the following factors might be involved in the likelihood of an Acom An rupture: the Acom is developmentally fragile, involves several blood vessels, is located deep in the brain, and adheres to the optic chiasma, in addition to the frontal lobe. These considerations indicate that direct surgical manipulation, especially for Acom Ans, can result in intraoperative ruptures and is thus very important for surgeons to bear in mind.
doi:10.2335/scs.49.247 fatcat:zflvjioltnhu5jxovcle4qisaa