To explore the risk factors of cerebral hernia after interventional surgery for ruptured intracranial aneurysms, and to establish a nomogram model to predict the risk of cerebral hernia after interventional surgery accordingly.

The clinical data of 398 patients with ruptured intracranial aneurysms who underwent interventional surgery therapy in Department of Neurology of Huishan District People's Hospital of Wuxi City from January 2017 to October 2022 were analyzed retrospectively, and they were divided into concurrent group and non-concurrent group according to the complications of postoperative cerebral hernia. The clinical data of the two groups were compared, and the risk factors of cerebral hernia after interventional surgery for ruptured intracranial aneurysms were analyzed by multivariate logistic regression analysis method, and a nomogram model for predicting the risk of cerebral hernia after interventional surgery for ruptured intracranial aneurysms was constructed according to the results of multivariate analysis, and Bootstrap method was used to internally verify the nomogram model and receiver operating characteristic (ROC) curve was used to evaluate the prediction efficiency of the nomogram model.

A total of 48 cases of 398 patients developed cerebral hernia after operation (the concurrent group), and the complication rate of cerebral hernia was 12.06%, and the rest were the non-concurrent group (350 cases). The proportions of hypertension history, Hunt-Hess grade Ⅳ-Ⅴ at admission, CT Fisher grade Ⅲ-Ⅳ at admission, World Federation of Neurosurgical Societies (WFNS) grade Ⅲ-Ⅴ at admission, operation time>2 h, hydrocephalus, brain edema, wide necked aneurysms and re rupture of aneurysms in the concurrent group were higher than those in the non-concurrent group, and the differences were statistically significant (P<0.05). Multivariate Logistic regression analysis showed that the history of hypertension, Hunt-Hess grade Ⅳ-Ⅴ at admission, CT Fisher grade Ⅲ-Ⅳ at admission, WFNS grade Ⅲ-Ⅴ at admission, operation time>2 h, wide necked aneurysms, brain edema and re rupture of aneurysms were the risk factors of cerebral hernia after interventional surgery for ruptured intracranial aneurysms (P<0.05). The nomogram model was constructed based on the above results of multivariate analysis, and the consistency index of it was 0.841, and ROC curve showed that the area under the curve of the nomogram model to predict the risk of cerebral hernia after interventional surgery for ruptured intracranial aneurysm was 0.836 (95%CI: 0.785-0.879, P<0.001), and the sensitivity was 83.33% and the specificity was 75.93%.

History of hypertension, Hunt-Hess grade at admission, CT Fisher grade at admission, WFNS grade at admission, wide necked aneurysms, brain edema and re rupture of aneurysms are the risk factors of brain hernia after interventional surgery for ruptured intracranial aneurysms, and the prediction nomogram model based on this has good discrimination, and the prediction efficiency is high, which can provide a reference for early individualized prediction of the risk of cerebral hernia and identification of high-risk patients.