Introduction: When Aneurysm surgery procedure is being learned, performance tends to improve with experience; however, in medicine there are no accurate measurements to monitor the said improvement. Experience of the surgeon plays an important role in dealing with aneurysm surgery while dissecting the aneurysm, clipping and controlling the bleeding if the aneurysm ruptures. Intra Operative Rupture (IOR) has been reported in a wide range of percentages during microsurgery, ranging from 3.5% to 50%. We would like to analyse the causes for IOR of intracranial aneurysms and strategies to control it. Aims: The aim of this study was to evaluate the incidence and reasons behind IOR and also to analyze the strategies of controlling hemorrhage. Material and Methods: A retrospective study was designed to analyze factors associated with IOR of intracranial aneurysms Over the Two-year period from 1 January 2014 to December 2016 at Nizam's Institute of Medical Sciences at the Neurosurgery Division, a total of 92 patients were operated for 100 brain aneurysms. The 92 patients who met the criteria were selected for inclusion in the study. Data collected from case records and operation notes. Results: 92 patients with 100 aneurysms were treated in this series. There were a total of 13 IORs which represented an IOR rate of 14.1% per patient and 13% per aneurysm. M=8, F= 5, Mean age 46.1 yrs, ( 27 - 65 yrs), No of patients with Grading of SAH according to Fisher was Gr.I-0,II-2,III-7,IV-4.Timing of rupture was during micro dissection 46%(6), during clipping 54%(7). Severity of IOR Bleeding were minor-4, moderate-7,Major-2. Outcomes in IOR pts were-Completely recovered-7, Hemiparesis occurred in-3,Decompressive craniectomy required in-2,No of pts died-1. Conclusions: High Fisher grade of ruptured aneurysms are associated with more chances of IOR. Avoiding undue retraction and sharp dissection around the aneurysm holds the key in preventing IORs.There is always a LEARNING CURVE in cerebrovascular surgery
