Perioperative Management of Craniotomy for Clipping Aneurysm: A Case Report
DOI:
https://doi.org/10.19166/med.v15i3.11624Keywords:
Perioperative management, Subarachnoid hemorrhage, Ruptured aneurysm, Craniotomy, Clipping aneurysm, Case ReportAbstract
Background:
Ruptured aneurysm is the most common cause of spontaneous subarachnoid hemorrhages. The clinical manifestations of aneurysmal subarachnoid hemorrhage are rapid onset of severe headache, loss of consciousness, nausea and/or vomiting, nuchal rigidity, or photophobia. The definitive treatment of the aneurysm is craniotomy and clipping or endovascular coiling. Several pathophysiological consequences of subarachnoid hemorrhage have been reported in previous studies. The role of the anesthesiologist is to acknowledge these sequelae in order to conduct a thorough pre anesthesia evaluation and to prepare perioperative management. However, case reports that discussed perioperative management of craniotomy for clipping aneurysm are still lacking.
Case Description:
We present a case of a 66-year-old woman diagnosed with acute non-communicating hydrocephalus, intraventricular hemorrhage pan-ventricle and subarachnoid hemorrhage in basal cistern, right and left sylvian fissure, right and left temporal due to aneurysm rupture post VP. Craniotomy for aneurysm clipping was planned and the surgery was done under general anesthesia. Intraoperatively, the patient’s hemodynamic was successfully maintained stable.
Conclusion:
Postoperatively, patient was closely monitored in the intensive care unit and no neurological deficits or other complications were found. This case report aims to further discuss the importance and concerns regarding the perioperative management of craniotomy for clipping aneurysm.
References
1. Kemenkes RI. Laporan nasional RISKESDAS 2018. Kementerian Kesehatan RI: Badan Penelitian dan Pengembangan Kesehatan. 2018.
2. Grasso G, Alafaci C, Macdonald RL. Management of aneurysmal subarachnoid hemorrhage: State of the art and future perspectives. Surg Neurol Int. 2017;8:11.
3. Hop JW, Rinkel GJ, Algra A, van Gijn J. Initial loss of consciousness and risk of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Stroke. 1999;30:2268–71.
4. Nahed BV, DiLuna ML, Morgan T, Ocal E, Hawkins AA, Ozduman K, et al. Hypertension, age, and location predict rupture of small intracranial aneurysms. Neurosurgery. 2005;57:676–83.
5. de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. Incidence of subarachnoid haemorrhage: A systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry. 2007;78:1365–72.
6. UCAS Japan Investigators, Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, et al The natural course of unruptured cerebral aneurysms in a Japanese cohort N Engl J Med. 2012;366:2474–82
7. Muirhead WR, Grover PJ, Toma AK, Stoyanov D, Marcus HJ, Murphy M. Adverse intraoperative events during surgical repair of ruptured cerebral aneurysms: A systematic review. Neurosurg Rev. 2021;44:1273–85
8. Ibrahim GM, Fallah A, Macdonald RL. Clinical, laboratory, and radiographic predictors of the occurrence of seizures following aneurysmal subarachnoid hemorrhage. J Neurosurg 2013;119:347–52.
9. Lele A, Lakireddy V, Gorbachov S, Chaikittisilpa N, Krishnamoorthy V, Vavilala MS. A narrative review of cardiovascular abnormalities after spontaneous intracerebral hemorrhage. J Neurosurg Anesthesiol. 2019;31:199–211.
10. Ridwan S, Zur B, Kurscheid J, Esche J, Kristof R, Klingmüller D, Boström A. Hyponatremia after spontaneous aneurysmal subarachnoid hemorrhage—A prospective observational study. World Neurosurg. 2019;129:e538–44.
11. Zoerle T, Lombardo A, Colombo A, Longhi L, Zanier ER, Rampini P, Stocchetti N. Intracranial pressure after subarachnoid hemorrhage. Crit Care Med. 2015;43:168–76.
12. Tsementzis SA, Hitchcock ER. Outcome from “rescue clipping” of ruptured intracranial aneurysms during induction anaesthesia and endotracheal intubation. J Neurol Neurosurg Psychiatry. 1985;48:160–3.
13. Sharma, D. Perioperative management of aneurysmal subarachnoid hemorrhage: a narrative review. Anesthesiology. 2020;133(6):1283-1305.
14. Connolly ES Jr., Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association Stroke. 2012;43:1711–37.
15. Kett-White R, Hutchinson PJ, Al-Rawi PG, Czosnyka M, Gupta AK, Pickard JD, Kirkpatrick PJ. Cerebral oxygen and microdialysis monitoring during aneurysm surgery: Effects of blood pressure, cerebrospinal fluid drainage, and temporary clipping on infarction. J Neurosurg. 2002;96:1013–9.
16. Akkermans A, van Waes JA, Peelen LM, Rinkel GJ, van Klei WA. Blood pressure and end-tidal carbon dioxide ranges during aneurysm occlusion and neurologic outcome after an aneurysmal subarachnoid hemorrhage. Anesthesiology. 2019;130:92–105.
17. Priebe HJ. Aneurysmal subarachnoid haemorrhage and the anaesthetist. British Journal of Anesthesia. 2007;99:102–18.
18. Zhao ZX, Wu C, He M. A systematic review of clinical outcomes, perioperative data and selective adverse events related to mild hypothermia in intracranial aneurysm surgery. Clin Neurol Neurosurg. 2012;114:827–32.
19. Mahaney KB, Todd MM, Bayman EO, Torner JC, IHAST Investigators. Acute postoperative neurological deterioration associated with surgery for ruptured intracranial aneurysm: Incidence, predictors, and outcomes. J Neurosurg. 2012;116:1267–78.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Damatus Try Hartanto Taopan, I Putu Pramana Suarjaya

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-SA 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website). The final published PDF should be used and bibliographic details that credit the publication in this journal should be included.


