Management of rupture during predissection phase in clipping of anterior circulation artery aneurysms

Objectives To summarize the operative experiences of anterior circulation artery aneurysms and to investigate the processing methods of rupture during predissection phase in clipping of anterior circulation artery aneurysms. Methods The data of 13 patients with rupture during predissection phase in anterior circulation aneurysm clipping were analyzed retrospectively. They were divided into either a progressive bleeding group or a stable bleeding group according to the status of intraoperative bleeding. In the progressive bleeding group, the blood immediately came out from the cortex or subdural space after the dura being opened. In the stable bleeding group, the high intracranial pressure was found after the dura being opened, and the preoperative state of consciousness was not consistent, the intraoperative head CT or B ultrasound examination found hematomas. The preoperative and intraoperative management of aneurysms and the postoperative clinical data were analyzed. Results Four patients with progressive bleeding: 2 had anterior communicating aneurysm, 1 had posterior communicating aneurysm, and 1 had middle cerebral artery aneurysm. Nine patients with stable bleeding: 3 had anterior communicating aneurysm, their frontal hematoma broke into the ventricles, and the ventricles were casted; 6 had middle cerebral artery aneurysm, they had temporal lobe intracerebral hematoma, and the hematoma volume was 30 to 50 mL. The aneurysms of 13 patients were totally clipped. In the progressive hemorrhage, one patient had intracranial infarction complicated by incomplete paralysis of unilateral limb, one died after procedure, and 1 had diabetes insipidus. No patients with stable bleeding died, 2 had incomplete paralysis of unilateral limb. Conclusions It is difficult to manage predissection rupture in the surgical clipping of anterior circulation aneurysm. Fast clipping the rupture and controlling bleeding are the keys of the surgery for the progressive bleeding. For stable bleeding, the intraoperative B ultrasound or head CT may timely detect hematomas and clip them after the removal of hematomas. Key words: Predissection rupture; Anterior circulation aneurysms; Clipping