Predictors and Clinical Impact of Major Intraoperative Rupture During Microsurgical Clipping of Intracranial Aneurysms: A Retrospective Cohort Study
DOI:
https://doi.org/10.52206/jsmc.2026.16.2.1418Abstract
Background: Intracranial aneurysms represent a critical neurosurgical condition due to their potential for rupture and subsequent subarachnoid hemorrhage, which carries substantial morbidity and mortality. Major intraoperative rupture (MIOR) during microsurgical clipping remains one of the most serious intraoperative complications, significantly affecting surgical safety and long-term patient outcomes.
Objective: To identify predictors of MIOR during microsurgical clipping of intracranial aneurysms and to evaluate its association with one-year postoperative functional outcomes.
Methodology: This retrospective cohort study was conducted at Hayatabad Medical Complex, Peshawar, from December 2022 to March 2024. A total of 168 patients undergoing 180 microsurgical aneurysm clipping procedures were included. Clinical variables such as age, gender, preoperative Glasgow Coma Scale (GCS), aneurysm rupture status, and surgeon experience were analyzed. MIOR was defined using standardized intraoperative criteria. Functional outcomes were assessed at one year using the modified Rankin Scale (mRS). Univariate and multivariate logistic regression analyses were performed to identify independent predictors.
Results: MIOR occurred in 23 of 180 procedures (12.8%). Multivariate analysis demonstrated that lower preoperative GCS (OR = 0.91; 95% CI: 0.84–0.99; p = 0.019) and surgeon inexperience (OR = 1.93; 95% CI: 1.10–3.51; p = 0.026) were independent predictors of MIOR. MIOR was strongly associated with poor functional outcome at one year (OR = 3.21; 95% CI: 1.74–5.93; p < 0.001).
Conclusion: Preoperative neurological status and surgeon experience are key determinants of intraoperative rupture risk during aneurysm clipping. MIOR significantly worsens long-term functional outcomes, emphasizing the importance of risk stratification, surgical expertise, and structured training to improve patient prognosis.
Keywords: Glasgow Coma Scale, Intracranial aneurysm, Intraoperative rupture, Microsurgical clipping, Predictors, Surgical experience.
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