A landmine during cranioplasty: unusual rupture of a previously undiagnosed aneurysm. Illustrative case

Several factors can precipitate intraoperative aneurysm rupture. Osmotic agents like mannitol can cause rapid intravascular fluid shifts, increasing hemodynamic stress across the aneurysm dome. Atmospheric pressure changes due to intraoperative manipulation can also alter extravascular forces on the aneurysm. Based on this experience, especially in young patients with prior unexplained hemorrhage, the authors advise careful use of mannitol and surgical technique. Surgeons should consider these risks in patients with known or suspected aneurysms to prevent catastrophic rupture. https://thejns.org/doi/10.3171/CASE25431.