Effect of intraoprative aneurysm rupture on perioperative complications and neurological outcome in adult patients undergoing surgical clipping for aneurysmal subarachnoid haemorrhage
Year: 2017
Type: conference-paper
Study design: Observational Study
Abstract: Introduction: Management of ruptured intracranial cerebral aneurysms remains formidable challenge despite the remarkable advancements in neurosurgery and neuroanaesthesia. Intraoperative rupture (IAR) is a well-known complication occurring during surgical clipping. We undertook this retrospective study to look for an association of IAR with perioperative complications and neurological outcome in adult patients who underwent surgical clipping for ruptured intracranial aneurysm with SAH. Methods: Data of all adult (Age >18 yrs) patients who underwent surgical clipping for aneurysmal subarachnoid haemorrhage (aSAH) at our institute between January 2013 and December 2014 was collected. The patients were then divided into two groups based on occurrence of IAR. Intraoperative complications and postoperative complications were noted. Neurological outcome was classified according to the Glasgow Outcome Scale (GOS) as favourable (grades IV and V) and unfavourable (grades I–III). Results: During the study period, a total 195 patients of aneurysmal SAH underwent surgical clipping, and their data was analysed. Patients were categorized into two groups – Group R with IAR and Group N without IAR. Demographic profile was comparable between the groups. Mean age of our study patients was 47.85 yrs. There were a total of 32 IARs out of the total of 195 patients, representing an IAR rate of 16.41%. The blood loss was significantly more as also the amounts of crystalloid, colloid and blood administered in Group R as compared to Group N. In the postoperative period requirement of prolonged ventilation was 50% in group R as compared to 27.61% in group N. The incidence of post-operative haematoma was 21.88% and 5.52%, post-operative infarct was 50% and 20.25%, and vasospasm was 25% and 22.09% and in group R and N respectively. The incidence of sepsis was 25% and 19.63%, pneumonia 21.88% and 15.34%, renal failure 6.25% and 4.29% and tracheostomy was done in 43.75% and 20.25% in group R and N respectively. Poor neurological outcome (GOS ≤3) was observed in 64 (39.26%) of patients without IAR as opposed to 20 (62.50%) in patients with IAR. Conclusion: IAR has significant impact on neurological outcome, although there was no significant difference in mortality. Postoperative complications like prolonged duration of mechanical ventilation, and operative site haematoma, requirement of tracheostomy, decompressive craniectomy and hospital length of stay was more in patients who had IAR.
Authors: N. Radhakrishna, R. Chouhan, M. Pandia
Institution: All India Institute of Medical Sciences
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2932744323