Intraoperative Risk Factors in Surgery of Cerebral Aneurysms

I.M. Godkov, V.V. Krilov

Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
Moscow State Medical-Stomatologic University, Moscow, Russia

 

The study goal has been more precise determination of intraoperative risk factors, deteriorating postoperative outcomes of cases with cerebral aneurysms (CA).

Material and Methods. Results of surgical treatment of 301 cases with subarachnoid hemorrhages (SAH), caused by CA rupture, were analyzed retrospectively. There were 149 males and 152 females, aged 15-73. Mean age was 46.7±11.6 years. According to Hunt-Kosnik scale, a degree of preoperative state severity was as follows: Ia-III 280 cases (93%), IV-V 21 cases (7%). Single and multiple CA were revealed in 234 (77.7%) and 67 (22.3%) cases, respectively. Open interventions were performed on the 1st-21st day after SAH in 192 (63.8%) cases and on the 22nd day and later in 109 (36.2%) cases.

Results. It was found out, that development of postoperative ischemic complications had been dependent on the following factors: brain retraction with duration of 110±20 min and more (R=0.19, p=0.03); arterial hypotension (reduction of mean blood pressure up to 80±18 mm Hg; R=0.12, p=0.04) and such complications, connected with aneurysm clipping (c2=6.3, p<0.02), as incomplete clipping of its neck and compression of perforating arteries by a clip. Deterioration of postoperative outcomes (the Glasgow Coma Scale) was caused by aneurysm rupture (c2=4.2, p=0.04); temporary clipping (20 min and more) of a mother artery (R=0.12, p<0.03); brain edema (c2=17.3, p<0.03) and arterial hypotension (mean blood pressure of less than 70 mm Hg) (c2=16.3, p<0.004). Complications, connected with aneurysm clipping, arterial hypotension, aneurysm rupture and brain edema, were dependent on such preoperative factors as age, state severity (Hunt-Kosnik scale), a degree of SAH according to Fisher, CA localization and angiospasm development.

Conclusion. Active prevention of intraoperative complications with taking into account preoperative factors can lead to improvement of postoperative outcomes.