Perioperative Variables Contributing to the Rupture of Intracranial Aneurysm: An Update

Table 1

Intraoperative variables contributing intracranial aneurysm rupture.

	Outcome
(1) Preprocedural factors (same for coiling procedures)
Anesthesia related	Poor
Pain
Light plane of anesthesia
Intubation response
Acute fluctuations in TMP
High blood pressure (induction, skull pin fixation, and incision)
Coughing/gagging
Raised ICP
Large and rapid bolus mannitol
Acute hyperventilation
(2) Intraprocedural factors	Variable
Increased vessel wall fragility (same for coiling procedures)	Poor
Smoking/COPD
Hyperlipidemia/CAD
Lower Hunt and Hess grade
Predissection phase	Poor
(Dural opening and arachnoid opening, hematoma removal, and brain retraction)
Dissection phase	Variable
Type of artery (PICA, ACA, and PCA)
Previously ruptured aneurysm
Surgeon’s experience