Introduction: We aim to investigate the effects of a series of potential predisposing factors including, primarily the surgical timing, comorbidities as well as pre- and perioperative blood pressure status, on both the development of intraoperative rupture and the outcomes.
Methods: This study was based on the retrospective analysis of our prospective aneurysmal subarachnoid hemorrhage patient database collected. A total of 278 cases having our inclusion criteria were used in our study. Demographic data, comorbidities, the use of anticoagulant and/or antiplatelet drugs, preoperative fluid-electrolyte imbalance, radiological data, preoperative and peroperative arterial blood pressure values, Hunt and Hess, Glasgow Coma Score, Fisher, Glasgow Outcome Score-Extended and modified Rankin scores were included.
Results: IOR was detected in 37 out of a total of 278 cases. A statistically difference was observed in the distribution of preoperative and peroperative AP values between our groups. According to the ROC Curve analysis, the Perop SYS-AP is >127 mmHG, the specificity for the risk of IOR development is 100%. The average time to surgery after aSAH in the group IOR (-) was 26.3 hours, whereas in cases where IOR (+) was found to be 11.8 hours (p < 0.001). The cut-off value was determined to be ≤18 hours (95% confidence interval; specificity: 95.2%, sensitivity: 94.59%). A positive correlation was found between the GCS and GOS-E, and between the Hunt-Hess, Fisher and the m-RANKIN (p < 0.001). A negative correlation was observed between the GCS and m-RANKIN, and between the Hunt-Hess, Fisher and the GOS-E (p < 0.001). In cases where IOR occurred during the predissection stage of operation, the GOS-E levels were statistically lower (p=0.002), and the m-RANKIN levels were higher (p=0.003) compared to those where rupture developed during the dissection stage.
Conclusion : Surgical timing as well as peroperative systolic arterial blood pressure pose a significant risk for intraoperative aneurysmal rupture during microsurgical clipping in the setting of subarachnoid hemorrhage.
