{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:42:58Z","timestamp":1779273778357,"version":"3.51.4"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,11]]},"abstract":"\nOBJECTIVE<\/jats:title>\nThis study was an investigation of surgical cases of a ruptured middle cerebral artery (MCA) aneurysm that was conducted to identify the risk factors of an intraoperative premature rupture.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nAmong 927 patients with a ruptured intracranial aneurysm who were treated over an 8-year period, the medical records of 182 consecutive patients with a ruptured MCA aneurysm were examined for cases of a premature rupture, and the risk factors were then investigated. The risk factors considered for an intraoperative premature rupture of an MCA aneurysm included the following: patient age; sex; World Federation of Neurosurgical Societies clinical grade; modified Fisher grade; presence of an intracerebral hemorrhage (ICH); location of the ICH (frontal or temporal); volume of the ICH; maximum diameter of the ruptured MCA aneurysm; length of the preaneurysmal M1<\/jats:sub> segment between the carotid bifurcation and the MCA aneurysm; and a sign of sphenoid ridge proximation. The sphenoid ridge proximation sign was defined as a spatial proximation < 4 mm between the sphenoid ridge and the rupture point of the MCA aneurysm, such as a daughter sac, irregularity, or dome of the aneurysm, based on the axial source images of the brain CT angiography sequences.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nA total of 11 patients (6.0%) suffered a premature rupture of the MCA aneurysm during surgery. The premature rupture occurrences were classified according to the stage of the surgery, as follows: 1) craniotomy and dural opening (n = 1); 2) aspiration or removal of the ICH (n = 1); 3) retraction of the frontal lobe (n = 1); 4) dissection of the sphenoid segment of the sylvian fissure to access the proximal vessel (n = 4); and 5) perianeurysmal dissection (n = 4). The multivariate analysis with a binary logistic regression revealed that presence of a sphenoid ridge proximation sign (p < 0.001), presence of a frontal ICH associated with the ruptured MCA aneurysm (p = 0.019), and a short preaneurysmal M1<\/jats:sub> segment (p = 0.043) were all statistically significant risk factors for a premature rupture. Plus, a receiver operating characteristic curve analysis revealed that a preaneurysmal M1<\/jats:sub> segment length \u2264 13.3 mm was the best cutoff value for predicting the occurrence of a premature rupture (area under curve 0.747; sensitivity 63.64%; specificity 81.66%).<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nPatients exhibiting a sphenoid ridge proximation sign, the presence of a frontal ICH, and\/or a short preaneurysmal M1<\/jats:sub> segment are at high risk for an intraoperative premature rupture of a MCA aneurysm. Such high-risk MCA aneurysms have a superficial location close to the arachnoid in the sphenoidal compartment of the sylvian fissure and have a rupture point directed anteriorly.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.10.jns151586","type":"journal-article","created":{"date-parts":[[2016,2,5]],"date-time":"2016-02-05T15:01:06Z","timestamp":1454684466000},"page":"1235-1241","source":"Crossref","is-referenced-by-count":15,"title":["Intraoperative premature rupture of middle cerebral artery aneurysms: risk factors and sphenoid ridge proximation sign"],"prefix":"10.3171","volume":"125","author":[{"given":"Jaechan","family":"Park","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and"},{"name":"Research Center for Neurosurgical Robotic Systems, Kyungpook National University; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wonsoo","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and"},{"name":"Research Center for Neurosurgical Robotic Systems, Kyungpook National University; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ki-Su","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and"},{"name":"Research Center for Neurosurgical Robotic Systems, Kyungpook National University; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong-Hun","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and"},{"name":"Research Center for Neurosurgical Robotic Systems, Kyungpook National University; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Im Hee","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, School of Medicine, Catholic University of Daegu, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns151586","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1227\/00006123-198606000-00004","article-title":"Intraoperative aneurysmal rupture: incidence, outcome, and suggestions for surgical management","volume":"18","author":"Batjer","year":"1986"},{"key":"b2-jns151586","series-title":"Neurosurgery","first-page":"2277","article-title":"Intraoperative aneurysm rupture","volume":"2","author":"Batjer","year":"1996"},{"key":"b3-jns151586","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1007\/s00701-012-1571-2","article-title":"Does the impact of elective temporary clipping on intraoperative rupture really influence neurological outcome after surgery for ruptured anterior circulation aneurysms?\u2014A prospective multivariate study","volume":"155","author":"Dhandapani","year":"2013"},{"key":"b4-jns151586","series-title":"Neurosurgery","first-page":"21","article-title":"Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale","volume":"59","author":"Frontera","year":"2006"},{"key":"b5-jns151586","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1227\/00006123-199104000-00008","article-title":"Management of intraoperative rupture of aneurysm without hypotension","volume":"28","author":"Giannotta","year":"1991"},{"key":"b6-jns151586","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1007\/s007010050428","article-title":"Intraoperative premature rupture of the cerebral aneurysms. 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