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  • Adverse events associated with microsurgial treatment for ruptured intracerebral aneurysms: a prospective nationwide study on subarachnoid haemorrhage in Sweden

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Neurosurgery
Original research
Adverse events associated with microsurgial treatment for ruptured intracerebral aneurysms: a prospective nationwide study on subarachnoid haemorrhage in Sweden
  1. Bryndís Baldvinsdóttir1,
  2. Erik Kronvall1,
  3. Elisabeth Ronne-Engström2,
  4. Per Enblad2,
  5. Peter Lindvall3,
  6. Helena Aineskog3,
  7. Steen Friðriksson4,
  8. Paula Klurfan4,
  9. Mikael Svensson5,
  10. Peter Alpkvist5,
  11. Jan Hillman6,
  12. Johanna Eneling6,
  13. Ola G Nilsson1
  1. 1 Department of Clinical Sciences, Neurosurgery, Lund University, Lund, Sweden
  2. 2 Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
  3. 3 Department of Clinical Sciences, Neurosurgery, Umea University, Umea, Sweden
  4. 4 Department of Clinical Neuroscience, Neurosurgery, University of Gothenburg, Gothenburg, Sweden
  5. 5 Department of Clinical Neuroscience, Neurosurgery, Karolinska Institute, Stockholm, Sweden
  6. 6 Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
  1. Correspondence to Dr Bryndís Baldvinsdóttir, Department of Clinical Sciences, Neurosurgery, Lund University, Lund 222 20, Sweden; bryndis.baldvinsdottir{at}med.lu.se

Abstract

Background Adverse events (AEs) or complications may arise secondary to the treatment of aneurysmal subarachnoid haemorrhage (SAH). The aim of this study was to identify AEs associated with microsurgical occlusion of ruptured aneurysms, as well as to analyse their risk factors and impact on functional outcome.

Methods Patients with aneurysmal SAH admitted to the neurosurgical centres in Sweden were prospectively registered during a 3.5-year period (2014–2018). AEs were categorised as intraoperative or postoperative. A range of variables from patient history and SAH characteristics were explored as potential risk factors for an AE. Functional outcome was assessed approximately 1 year after the bleeding using the extended Glasgow Outcome Scale.

Results In total, 1037 patients were treated for ruptured aneurysms, of which, 322 patients were treated with microsurgery. There were 105 surgical AEs in 97 patients (30%); 94 were intraoperative AEs in 79 patients (25%). Aneurysm rerupture occurred in 43 patients (13%), temporary occlusion of the parent artery >5 min in 26 patients (8%) and adjacent vessel injury in 25 patients (8%). High Fisher grade and brain oedema on CT were related to increased risk of AEs. At follow-up, 38% of patients had unfavourable outcome. Patients suffering AEs were more likely to have unfavourable outcome (OR 2.3, 95% CI 1.10 to 4.69).

Conclusion Intraoperative AEs occurred in 25% of patients treated with microsurgery for ruptured intracerebral aneurysm in this nationwide survey. Although most operated patients had favourable outcome, AEs were associated with increased risk of unfavourable outcome.

  • SUBARACHNOID HAEMORRHAGE
  • CEREBROVASCULAR DISEASE
  • NEUROSURGERY

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/jnnp-2022-330982

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors BB: collection, data analysis and interpretation, drafting the article, critical revision of the article, approval of the submitted article,. Corresponding author EK: data collection, data analysis and interpretation, drafting the article, critical revision of the article, approval of the submitted article. ER-E: designing the study database, data collection, critical revision of the article, approval of the submitted article. PE: designing the study database, data collection, critical revision of the article, approval of the submitted article. PL: designing the study database, data collection, critical revision of the article, approval of the submitted article. HA: data collection, critical revision of the article, approval of the submitted article. SF: designing the study database, critical revision of the article, approval of the submitted article. PK: data collection, critical revision of the article, approval of the submitted article. MS: designing the study database, data collection, critical revision of the article, approval of the submitted article. PA: data collection, critical revision of the article, approval of the submitted article. JH: designing the study database, data collection, critical revision of the article, approval of the submitted article. JE: data collection, critical revision of the article, approval of the submitted article. OGN: designing the study database, data collection, data analysis and interpretation, drafting the article, critical revision of the article, approval of the submitted article, writer of the cover letter. OGN is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.