[Peroperative aneurysmal rupture: role and consequences of temporary clamping]

Abstract

Intraoperative rupture of a cerebral aneurysm is not always controlled by anaesthesiological and surgical methods. Its frequency is about 7 to 36% of procedures. Prevention by induced hypotension is by itself a factor of morbidity since regional circulatory disturbances are issued from subarachnoid hemorrhage (hypovolemia, dysautoregulation, vasospasm...). Temporary clipping of aneurysm adjacent arteries is a feasible method of preventing rupture, also during microsurgical management of some dangerous localizations as anterior communicating artery or basilar artery. Clinical course improves with prepared clipping, early methods for cerebral protection, and preventing microcirculatory disturbances during occlusion and blood flow restoration. Unusual anaesthesiological means, hemodynamic and hemorheological supports are required for these purposes.