Analysis of intraoperative rupture in the surgical treatment of 1694 saccular aneurysms
Analysis of intraoperative rupture in the surgical treatment of 1694 saccular aneurysms
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DOI：
10.1227/01.neu.0000154697.75300.c2
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发表时间：
2005-03-01
期刊：
影响因子：
4.8
通讯作者：
Johnson, CS
中科院分区：
文献类型：
--
作者：
Leipzig, TJ;Morgan, J;Johnson, CS
目的：术中动脉瘤破裂(IOR)是颅内动脉瘤外科治疗中的一种已知风险。这项研究的目的是确定IOR在现代外科手术系列中的发生率，并评估哪些因素与其有关。方法：本研究回顾了1986至1998年间手术治疗的1269例囊性动脉瘤患者。三位血管神经外科医生对1694个动脉瘤进行了1435次手术。结果：共发生IOR 113例，每次手术占7.9%，每次动脉瘤占6.7%，每例占8.9%。如果排除59个“轻微漏”(如先前发表的报告所述)，则每个手术的发病率为3.8%，每个动脉瘤的发病率为3.2%，每个患者的发病率为4.3%。术中小脑后下动脉和前、后交通动脉瘤更易破裂。破裂动脉瘤的IOR率高于未破裂动脉瘤(10.7vs1.2%，P<；0.0001)。使用临时动脉闭塞的手术的IOR率较低(3.1vs8.6%，P<；0.0001)。蛛网膜下腔出血后3d以上早期手术的IOR发生率(11.1%)与术后3d以上手术的IOR发生率(10.0%)差异无统计学意义(P=0.6234)。结论：蛛网膜下腔出血后早期手术明显IOR的发生率可维持在较低水平。动脉瘤部位、蛛网膜下腔出血、暂时性动脉闭塞似乎是影响IOR发生率的重要因素。
OBJECTIVE: Intraoperative rupture (IOR) of an aneurysm is a known risk in the surgical management of intracranial aneurysms. The purpose of this study was to determine the incidence of IOR in a modern surgical series and to assess which factors bear upon it.METHODS: This study retrospectively examined 1269 patients with saccular aneurysms treated surgically between 1986 and 1998. Three vascular neurosurgeons performed 1435 operations on 1694 aneurysms. Multiple factors, including the magnitude and time of occurrence of IOR, aneurysm location, subarachnoid hemorrhage, timing of surgery, and use of temporary occlusion, were analyzed.RESULTS: There were 113 instances of IOR (7.9% per surgery; 6.7% per aneurysm; 8.9% per patient). If the 59 "minor leaks" are excluded (as in previously published reports), the incidence becomes 3.8% per surgery, 3.2% per aneurysm, and 4.3% per patient. Posteroinferior cerebellar artery and anterior and posterior communicating artery aneurysms were more liable to rupture intraoperatively. The IOR rate was greater in ruptured than unruptured aneurysms (10.7 versus 1.2%, P < 0.0001). There was a lower rate of IOR in operations using temporary arterial occlusion (3.1 versus 8.6%, P < 0.0001). The occurrence of IOR for early surgery was not significantly higher than for surgery performed more than 3 days after subarachnoid hemorrhage (11.1 versus 10.0%, P = 0.6234).CONCLUSION: The rate of significant IOR can be kept low. Aneurysm location, subarachnoid hemorrhage, and temporary arterial occlusion seem to be important factors affecting the incidence of IOR.