Adverse intraoperative events during surgical repair of ruptured cerebral aneurysms: a systematic review

Muirhead, William; Grover, Patrick; Toma, Ahmed K; Stoyanov, Danail; Marcus, Hani J.; Murphy, Mary

doi:10.1007/s10143-020-01312-4

Cited by 15 publications

(18 citation statements)

References 58 publications

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“…Notably, in the literature, the most commonly reported adverse event is intraoperative rupture ( 28 ) that may reflect the binary nature of rupture, which lends itself to reporting in case series. The most-reported technical challenge of neck reconstruction/clip placement is reflected in the literature by a rate of suboptimal clip placement being recognised intraoperatively in 15.5% of cases.…”

Section: Discussionmentioning

confidence: 99%

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Microsurgery for intracranial aneurysms: A qualitative survey on technical challenges and technological solutions

et al. 2022

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IntroductionMicrosurgery for the clipping of intracranial aneurysms remains a technically challenging and high-risk area of neurosurgery. We aimed to describe the technical challenges of aneurysm surgery, and the scope for technological innovations to overcome these barriers from the perspective of practising neurovascular surgeons.Materials and MethodsConsultant neurovascular surgeons and members of the British Neurovascular Group (BNVG) were electronically invited to participate in an online survey regarding surgery for both ruptured and unruptured aneurysms. The free text survey asked three questions: what do they consider to be the principal technical barriers to aneurysm clipping? What technological advances have previously contributed to improving the safety and efficacy of aneurysm clipping? What technological advances do they anticipate improving the safety and efficacy of aneurysm clipping in the future? A qualitative synthesis of responses was performed using multi-rater emergent thematic analysis.ResultsThe most significant reported historical advances in aneurysm surgery fell into five themes: (1) optimising clip placement, (2) minimising brain retraction, (3) tissue handling, (4) visualisation and orientation, and (5) management of intraoperative rupture. The most frequently reported innovation by far was indocyanine green angiography (84% of respondents). The three most commonly cited future advances were hybrid surgical and endovascular techniques, advances in intraoperative imaging, and patient-specific simulation and planning.ConclusionsWhile some surgeons perceive that the rate of innovation in aneurysm clipping has been dwarfed in recent years by endovascular techniques, surgeons surveyed highlighted a broad range of future technologies that have the potential to continue to improve the safety of aneurysm surgery in the future.

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Section: Discussionmentioning

confidence: 99%

“…Despite the long history of innovation in open aneurysm repair, treatment remains technically demanding with a high complication rate ( 28 ). In one series of ruptured aneurysms treated with surgical clipping, 36% of the deaths and permanent disabilities were attributed to technical intraoperative complications ( 29 ).…”

Section: Introductionmentioning

confidence: 99%

Microsurgery for intracranial aneurysms: A qualitative survey on technical challenges and technological solutions

et al. 2022

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“…Aneurysmal subarachnoid haemorrhage (SAH) is a severe disease with high morbidity and mortality 1 2. In addition to the direct injury from the bleeding, a spectrum of adverse events (AEs) may occur during the clinical course 3–6. These events can be caused by the haemorrhage itself or the clinical treatment.…”

Section: Introductionmentioning

confidence: 99%

Adverse events associated with microsurgial treatment for ruptured intracerebral aneurysms: a prospective nationwide study on subarachnoid haemorrhage in Sweden

Baldvinsdóttir

Kronvall

Ronne-Engström

et al. 2023

J Neurol Neurosurg Psychiatry

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BackgroundAdverse events (AEs) or complications may arise secondary to the treatment of aneurysmal subarachnoid haemorrhage (SAH). The aim of this study was to identify AEs associated with microsurgical occlusion of ruptured aneurysms, as well as to analyse their risk factors and impact on functional outcome.MethodsPatients with aneurysmal SAH admitted to the neurosurgical centres in Sweden were prospectively registered during a 3.5-year period (2014–2018). AEs were categorised as intraoperative or postoperative. A range of variables from patient history and SAH characteristics were explored as potential risk factors for an AE. Functional outcome was assessed approximately 1 year after the bleeding using the extended Glasgow Outcome Scale.ResultsIn total, 1037 patients were treated for ruptured aneurysms, of which, 322 patients were treated with microsurgery. There were 105 surgical AEs in 97 patients (30%); 94 were intraoperative AEs in 79 patients (25%). Aneurysm rerupture occurred in 43 patients (13%), temporary occlusion of the parent artery >5 min in 26 patients (8%) and adjacent vessel injury in 25 patients (8%). High Fisher grade and brain oedema on CT were related to increased risk of AEs. At follow-up, 38% of patients had unfavourable outcome. Patients suffering AEs were more likely to have unfavourable outcome (OR 2.3, 95% CI 1.10 to 4.69).ConclusionIntraoperative AEs occurred in 25% of patients treated with microsurgery for ruptured intracerebral aneurysm in this nationwide survey. Although most operated patients had favourable outcome, AEs were associated with increased risk of unfavourable outcome.

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“…According to the recent meta-analysis, patients with HH grade I have lower risk of developing CVS [7]. In poor-grade aSAH patients urgent surgical clipping provided little benefit considering potential intraoperative injury (i.e., aneurysm rupture, difficult exposure, prolonged temporary clipping, blood loss and transfusions, and intraoperative hyper/hypotension) [8]. The new recommendation endorses endovascular coiling in the elderly, poor-grade aSAH, and aneurysms of the basilar tip [9].…”

Section: Introductionmentioning

confidence: 99%

“…Prevention and treatment of CVS remains a matter of debate. Established approaches are the administration of nimodipine initially intravenously then orally and maintenance of euvolemia, as well as treatment with hemodynamic augmentation therapy or endovascular therapy with vasodilators and angioplasty balloons [8]. A recent study also suggested the potential use of heparin [15].…”

Section: Introductionmentioning

confidence: 99%

Plasma Amino Acids May Improve Prediction Accuracy of Cerebral Vasospasm after Aneurysmal Subarachnoid Haemorrhage

Bobeff

Bukowiecka‐Matusiak

Stawiski

et al. 2022

JCM

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Aneurysmal subarachnoid haemorrhages (aSAH) account for 5% of strokes and continues to place a great burden on patients and their families. Cerebral vasospasm (CVS) is one of the main causes of death after aSAH, and is usually diagnosed between day 3 and 14 after bleeding. Its pathogenesis remains poorly understood. To verify whether plasma concentration of amino acids have prognostic value in predicting CVS, we analysed data from 35 patients after aSAH (median age 55 years, IQR 39–62; 20 females, 57.1%), and 37 healthy volunteers (median age 50 years, IQR 38–56; 19 females, 51.4%). Fasting peripheral blood samples were collected on postoperative day one and seven. High performance liquid chromatography-mass spectrometry (HPLC-MS) analysis was performed. The results showed that plasma from patients after aSAH featured a distinctive amino acids concentration which was presented in both principal component analysis and direct comparison. No significant differences were noted between postoperative day one and seven. A total of 18 patients from the study group (51.4%) developed CVS. Hydroxyproline (AUC = 0.7042, 95%CI 0.5259–0.8826, p = 0.0248) and phenylalanine (AUC = 0.6944, 95%CI 0.5119–0.877, p = 0.0368) presented significant CVS prediction potential. Combining the Hunt-Hess Scale and plasma levels of hydroxyproline and phenylalanine provided the model with the best predictive performance and the lowest leave-one-out cross-validation of performance error. Our results suggest that plasma amino acids may improve sensitivity and specificity of Hunt-Hess scale in predicting CVS.

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Adverse intraoperative events during surgical repair of ruptured cerebral aneurysms: a systematic review

Cited by 15 publications

References 58 publications

Microsurgery for intracranial aneurysms: A qualitative survey on technical challenges and technological solutions

Microsurgery for intracranial aneurysms: A qualitative survey on technical challenges and technological solutions

Adverse events associated with microsurgial treatment for ruptured intracerebral aneurysms: a prospective nationwide study on subarachnoid haemorrhage in Sweden

Plasma Amino Acids May Improve Prediction Accuracy of Cerebral Vasospasm after Aneurysmal Subarachnoid Haemorrhage

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