Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Intraoperative rupture during microsurgical clipping of intracranial aneurysms: a systematic review and meta-analysis of incidence and outcomes.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Davies Lily, Raki Cyrus, Silva Zenuka De, Lai Leon
Аннотация
BACKGROUND AND OBJECTIVE: Intraoperative rupture (IOR) is a recognised complication of microsurgical aneurysm clipping, yet reported incidence and outcomes remain vary widely across published series. We performed a systematic review and meta-analysis to estimate the pooled IOR incidence and examine its association with postoperative morbidity and mortality.
METHODS: This review was registered with PROSPERO (CRD420251051680) and conducted in accordance with PRISMA guidelines. MEDLINE, Embase, Emcare, Scopus and Cochrane were searched from January 1, 2005 to May 12, 2025. Eligible studies reported IOR in at least 20 surgically clipped aneurysms. Risk of bias was assessed using MINORS. The primary outcome was pooled IOR incidence, stratified by rupture status and arterial location. Secondary outcomes were morbidity and mortality, analysed as pooled proportions and odds ratios using random effects models.
RESULTS: Seventy-eight studies comprising 19,243 clipped aneurysms and 2213 IOR events met inclusion criteria. The pooled IOR incidence was 12.6% (95% CI, 10.1-15.6%; I2 = 94%). IOR occurred more frequently in ruptured than unruptured aneurysms (14.4% vs 2.2%). Incidence varied by arterial location, with lowest rates in pericallosal aneurysms. Aneurysm size showed no consistent association with IOR. Mortality following IOR was 9.1% (95% CI, 5.0-16.2%). Compared with non IOR cases, IOR was associated with higher odds of mortality (OR, 4.14; 95% CI, 1.67-10.27) and morbidity (OR, 3.33; 95% CI, 1.88-5.90).
CONCLUSION: Intraoperative rupture occurred in approximately 1 in 8 aneurysms treated with microsurgical clipping and was associated with higher morbidity and mortality. Reported incidence varied by rupture status and arterial location, while aneurysm size showed no consistent association. Marked heterogeneity, inconsistent IOR definitions, and complete outcome reporting underscore the need for standardised reporting and prospective patient level data to better characterise the clinical impact of IOR.
METHODS: This review was registered with PROSPERO (CRD420251051680) and conducted in accordance with PRISMA guidelines. MEDLINE, Embase, Emcare, Scopus and Cochrane were searched from January 1, 2005 to May 12, 2025. Eligible studies reported IOR in at least 20 surgically clipped aneurysms. Risk of bias was assessed using MINORS. The primary outcome was pooled IOR incidence, stratified by rupture status and arterial location. Secondary outcomes were morbidity and mortality, analysed as pooled proportions and odds ratios using random effects models.
RESULTS: Seventy-eight studies comprising 19,243 clipped aneurysms and 2213 IOR events met inclusion criteria. The pooled IOR incidence was 12.6% (95% CI, 10.1-15.6%; I2 = 94%). IOR occurred more frequently in ruptured than unruptured aneurysms (14.4% vs 2.2%). Incidence varied by arterial location, with lowest rates in pericallosal aneurysms. Aneurysm size showed no consistent association with IOR. Mortality following IOR was 9.1% (95% CI, 5.0-16.2%). Compared with non IOR cases, IOR was associated with higher odds of mortality (OR, 4.14; 95% CI, 1.67-10.27) and morbidity (OR, 3.33; 95% CI, 1.88-5.90).
CONCLUSION: Intraoperative rupture occurred in approximately 1 in 8 aneurysms treated with microsurgical clipping and was associated with higher morbidity and mortality. Reported incidence varied by rupture status and arterial location, while aneurysm size showed no consistent association. Marked heterogeneity, inconsistent IOR definitions, and complete outcome reporting underscore the need for standardised reporting and prospective patient level data to better characterise the clinical impact of IOR.