Key result
Higher Hunt and Hess grade was a significant predictor of intraoperative aneurysm rupture during surgical clipping (OR 2.3; 95% CI 1.1-5.0; P=0.03), which did not worsen long-term clinical outcomes.
Why the study?
What are the risk factors for intraoperative aneurysm rupture during surgical clipping for aneurysmal subarachnoid hemorrhage, and does it affect patient outcomes?
Observational (n=100)
What are the risk factors for intraoperative aneurysm rupture during surgical clipping for aneurysmal subarachnoid hemorrhage, and does it affect patient outcomes?
Odds Ratio: 2.3 (95% CI 1.1–5)
p-value: p=0.03
Higher Hunt and Hess grade and the presence of a spot sign are associated with intraoperative aneurysm rupture during clipping, though this complication does not appear to worsen long-term clinical outcomes.
May warrant closer monitoring in high-grade SAH; leaves open whether targeted strategies reduce rupture without outcome benefit in cohorts.
OBJECTIVE: To assess clinical and radiographic risk factors for intraoperative aneurysm rupture (ioAR) during surgical clipping after aneurysmal subarachnoid hemorrhage (aSAH) and to analyze its influence on patient outcome. METHODS: Patient selection was based on a retrospective analysis of our prospective subarachnoid hemorrhage patient database including consecutive patients between January 2008 and August 2012 with aSAH undergoing microsurgical clipping. Demographic data, cardiovascular risk factors, preoperative radiologic aneurysm characteristics, as well as timing of surgery and preoperative severity grades (Hunt and Hess [HH], Fisher, World Federation of Neurological Societies [WFNS]), were collected from hospital charts and surgery videos and compared between patients with and without ioAR. RESULTS: Of 100 patients (38 men, 62 women) with a median age of 57.4 years (range: 23-85 years), ioAR occurred in 34 cases (34%). Univariate analyses showed that severity grades were significantly higher in the ioAR group (Fisher p = 0.012; HH p = 0.002; WFNS p = 0.023). IoAR was significantly associated with intracerebral hemorrhage (ICH) (23% versus 47%; p = 0.013) and the spot sign as an indicator of active bleeding within the ICH (0% vs 44%; p = 0.007). Multivariate analysis showed that HH was the only significant predictor of ioAR (p = 0.03; odds ratio: 2.3; 95% confidence interval, 1.1-5.0). With a mean follow-up of 17.6 months ( ± 16.6), Glasgow Outcome Scale score, mortality rate (12% versus 15%; p = 0.82), delayed cerebral ischemia (36% versus 38%; p = 0.51), and shunt dependency (32% versus 44%; p = 0.23) were comparable between the non-ioAR and ioAR group. CONCLUSIONS: Initial clinical status and spot sign were associated with ioAR during microsurgical clipping of ruptured aneurysms. However, there was no difference regarding clinical outcome and complications of the two groups.
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Mohme et al. (2015) conducted an observational in Aneurysmal subarachnoid hemorrhage (aSAH) (n=100). Hunt and Hess grade vs. Lower Hunt and Hess grade was evaluated on Intraoperative aneurysm rupture (ioAR) (OR 2.3, 95% CI 1.1-5.0, p=0.03). Higher Hunt and Hess grade was a significant predictor of intraoperative aneurysm rupture during surgical clipping (OR 2.3; 95% CI 1.1-5.0; P=0.03), which did not worsen long-term clinical outcomes.
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