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CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(02): 301-313
DOI: 10.1055/s-0045-1804529
Original Article

Outcome Determinant of Patients Following Microsurgical Clipping of Ruptured Intracranial Aneurysms

Gopal R. Sharma
1   Department of Neurosciences, Nepal Mediciti Hospital, Sainbu, Lalitpur, Nepal
,
Prasanna Karki
1   Department of Neurosciences, Nepal Mediciti Hospital, Sainbu, Lalitpur, Nepal
,
Sumit Joshi
1   Department of Neurosciences, Nepal Mediciti Hospital, Sainbu, Lalitpur, Nepal
,
Damber Bikram Shah
1   Department of Neurosciences, Nepal Mediciti Hospital, Sainbu, Lalitpur, Nepal
,
Prakash Paudel
1   Department of Neurosciences, Nepal Mediciti Hospital, Sainbu, Lalitpur, Nepal
,
Baburam Pokharel
1   Department of Neurosciences, Nepal Mediciti Hospital, Sainbu, Lalitpur, Nepal
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Funding None.
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Abstract

Objectives Numerous factors can influence patient outcomes following microsurgical clipping of intracranial aneurysms (IAs). Some unique factors, such as aneurysm surgery during the COVID-19 pandemic, also play a role. This study aims to evaluate outcomes in patients with ruptured IAs undergoing microsurgical clipping and identify predictors for both immediate and long-term prognosis.

Materials and Methods This is a retrospective study with prospectively collected data of 500 patients with ruptured aneurysms undergoing microsurgical clipping over a period of 10 years (April 2011–November 2022). The follow-up period ranged from 2 to 10 years, and clinical outcomes were evaluated using the Glasgow Outcome Scale (GOS). Data were analyzed using STATA version 3.10. Logistic regression was used to calculate p-values, with a significance level of p < 0.05.

Results Among 500 patients treated for ruptured IAs, 169 were males and 331 were females, with a median age of 53 years. Postoperative vasospasm was a major predictor of worse outcomes at discharge (p < 0.001), 6 months (p < 0.001), 1 year (p < 0.001), 5 years (p = 0.014), and 10 years (p = 0.006). Patients treated during the COVID-19 pandemic had worse outcomes at 6 months (p < 0.001) and 1 year (p = 0.001).

Conclusion Postoperative vasospasm, intraoperative rupture, and the COVID-19 pandemic were the most important predictors of worse outcomes. Factors such as age, hospital type, Miller Fisher grade, alcohol abuse, diabetes, aneurysm multiplicity, aneurysm size, neck size, ethnicity, hydrocephalus, brain retraction, and lamina terminalis fenestration did not significantly influence the outcomes.

Keywords

aneurysm - ruptured - intracranial aneurysm - microsurgery - subarachnoid hemorrhage - Glasgow Outcome Scale


Publication History

Article published online:
20 February 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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