1201. Risk Factors and Outcomes for Intraoperative Aneurysm Rupture During Surgical Clipping

Authors: Leonardo B. C. Brasiliense, MD; Peyton Nisson, BS; Arnau Benet, MD; Ali Meybodi, MD; Garrett Berger, PharmD; Michael Lawton, MD (Tucson, AZ)

Introduction: Intraoperative aneurysm rupture is one of the most feared complications of surgically treated aneurysms. Although rare, they can have devastating effects including shock, stroke, and even death. We investigated risk factors for intraoperative rupture and compared the outcomes to patients who had uneventful clipping. Methods: Aneurysms treated by the senior author (M.T.L.) were included from a database spanning January 2010 to April 2013. Aneurysm characteristics, medical history, demographics, and outcomes were obtained. Patients with intraoperative rupture were compared to patients with uneventful clipping. Neurologic status was assessed using the mRS scale. Neurologic outcomes were dichotomized between ‘good’ (mRS 0-2) and ‘poor’ (mRS 3-6). Wilcoxon rank-sum was used for continuous variables and Fisher’s exact test for categorical variables. Results: A total of 334 patients were identified. The rate of intraoperative rupture was 4.5% (15/344). No differences were found in the ruptured group versus the non-ruptured group regarding mean age (57 years vs 57 years; p=.94), tobacco use (5% vs. 3%; p=.41), pack years (21 vs. 10; p=.62), alcohol use (6% vs. 4%; p=.44), hypertension (3% vs. 7%; p=.06), aneurysm size (5.8 mm vs. 7.2 mm; p=.34), proportion of posterior circulation aneurysms (9% vs. 4%), and previous SAH (5% vs. 4%; p=1.0). Patients with intraoperative rupture had worse outcomes compared to non-ruptured patients (mRS 3-6: 40% vs. 18%, respectively; p=.04). No difference in post-operative complications including hyponatremia (7% vs. 8%; p=1.0), seizure (0% vs. 2%; p=1.0), hydrocephalus (0% vs. 5%; p=1.0), or persistent headaches (0% vs. 2%; p=1.0) was found. Conclusion: Our study demonstrated a low rate of intraoperative rupture in experienced hands although we were unable to identify risk factors. We showed that these patients have a worse outcome. Further studies are needed to determine which patients and aneurysms are at an increased risk of intraoperative rupture.