Compared with endovascular techniques, clipping of ruptured cerebral aneurysms has been shown to associate with increased morbidity in several studies. Despite this, clipping remains the preferred option for many aneurysms. The objective of this study is to describe the reported adverse events of open repair of ruptured cerebral aneurysms and their impact on patient outcome. The PubMed, Embase and Cochrane databases were searched between June 1999 and June 2019 to identify original studies of at least 100 patients undergoing surgical repair of ruptured cerebral aneurysms and in which adverse event rates were reported. Thirty-six studies reporting adverse events in a total of 12,410 operations for repair of ruptured cerebral aneurysms were included. Surgical adverse events were common with 36 event types reported including intraoperative rupture (median rate of 16.6%), arterial injury (median rate of 3.8%) and brain swelling (median rate 5.6%). Only 6 surgical events were statistically shown to associate with poor outcomes by any author and for intraoperative rupture (the most frequently analysed), there was an even split between authors finding a statistical association with poor outcome and those finding no association. Even with modern surgical techniques, the technical demands of surgical aneurysm repair continue to lead to a high rate of intraoperative adverse events. Despite this, it is not known which of these intraoperative events are the most important contributors to the poor outcomes often seen in these patients. More research directed towards identifying the events that most drive operative morbidity has the potential to improve outcomes for these patients.

与血管内技术相比，几项研究表明，夹闭破裂的脑动脉瘤与增加的发病率有关。尽管如此，夹闭仍然是许多动脉瘤的首选。本研究的目的是描述已报告的破裂脑动脉瘤开放修复术的不良事件及其对患者预后的影响。在 1999 年 6 月至 2019 年 6 月期间搜索了 PubMed、Embase 和 Cochrane 数据库，以确定至少 100 名接受破裂脑动脉瘤手术修复的患者的原始研究，其中报告了不良事件发生率。纳入了 36 项研究，报告了总共 12,410 次脑动脉瘤破裂修复手术中的不良事件。手术不良事件在 36 种事件类型中很常见，包括术中破裂（中位数为 16.6%）、动脉损伤（中位数为 3.8%）和脑肿胀（中位数为 5.6%）。任何作者都统计显示只有 6 次手术事件与不良结果相关，对于术中破裂（最常分析的），发现与不良结果有统计学关联的作者和发现无关联的作者之间存在平均分歧。即使采用现代手术技术，手术动脉瘤修复的技术要求仍继续导致术中不良事件的发生率很高。尽管如此，尚不清楚这些术中事件中哪些是导致这些患者经常出现的不良结果的最重要因素。