Clinicoradiological profile and outcome of microsurgical clipping of ruptured anterior circulation aneurysms: A single-institute experience

Introduction: Prevalence of intracranial aneurysms is estimated to be from 1% to 5% of population, most of them are small and located in the anterior circulation. The real danger is when an aneurysm ruptures, leading to a subarachnoid hemorrhage (SAH). SAH is a catastrophic event with a mortality rate of 25% to 50%. Permanent disability occurs in nearly 50% of the survivors. Fifteen percent of patients expire before reaching the hospital and 25% die within 24 h. The purpose of our study is to report the clinicoradiological data and outcome of microsurgical clipping of ruptured anterior circulation aneurysms in our center. Materials and Methods: This study included ruptured anterior circulation aneurysms admitted to tertiary care hospital in northern India from January 2018 to June 2020. The final outcome of patients was analyzed with Glasgow Outcome Score (GOS) at the time of discharge from the hospital. Results: A total of 53 patients with ruptured anterior circulation aneurysm underwent microsurgical clipping comprising 25 (47.2%) males and 28 (52.8%) females. The mean neck size of all aneurysms was 3.43 ± 1.66 mm. The mean hospital stay was longer in patients having preoperative intraventricular hemorrhage (IVH) (35.96 ± 27.27 days) and postoperative complications (43.36 ± 29.76 days) compared to patients who did not have IVH (21.10 ± 15.47 days) and postoperative complications (18 ± 6.54 days). P value was ≤0.05. Patients with preoperative hydrocephalus had GOS 3.44 ± 1.20 at discharge compared to nonhydrocephalus who had GOS 4.32 ± 1.07 (P = 0.009). Patients with Intracerebral Hemorrhage (ICH) and non-ICH had GOS 3.31 ± 1.38 and 4.28 ± 1.01, respectively (P = 0.009). Conclusion: Poor outcome at the time of discharge after the surgical treatment of anterior circulation aneurysms was associated with poor world federation of neurological surgeons grade on admission, presence of IVH, hydrocephalus, intracerebral hemorrhage, and postoperative cerebral infarcts.

Key-words:

Aneurysm - clipping - infarct - outcome - world federation of neurological surgeons

• References

• 1 van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: Diagnosis, causes and management. Brain 2001;124:249-78.
• 2 Hernesniemi J, Dashti R, Lehecka M, Niemelä M, Rinne J, Lehto H, et al. Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol 2008;70:8-28.
• 3 Hop JW, Rinkel GJ, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: A systematic review. Stroke 1997;28:660-4.
• 4 Jane JA, Winn HR, Richardson AE. The natural history of intracranial aneurysms: Rebleeding rates during the acute and long term period and implication for surgical management. Clin Neurosurg 1977;24:176-84.
• 5 Dorhout Mees SM, Molyneux AJ, Kerr RS, Algra A, Rinkel GJ. Timing of aneurysm treatment after subarachnoid hemorrhage: Relationship with delayed cerebral ischemia and poor outcome. Stroke 2012;43:2126-9.
• 6 Rinkel GJ, Djibuti M, Algra A, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: A systematic review. Stroke 1998;29:251-6.
• 7 Samandouras G. Subarachnoid Haemorrhage 1: Diagnosis the Neurosurgeon's Handbook. Oxford; Oxford University Press; 2010.
• 8 Schöller K, Massmann M, Markl G, Kunz M, Fesl G, Brückmann H, et al. Aneurysmal subarachnoid hemorrhage in elderly patients: Long-term outcome and prognostic factors in an interdisciplinary treatment approach. J Neurol 2013;260:1052-60.
• 9 Chotai S, Ahn SY, Moon HJ, Kim JH, Chung HS, Chung YG, et al. Prediction of outcomes in young adults with aneurysmal subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 2013;53:157-62.
• 10 Bohnstedt BN, Nguyen HS, Kulwin CG, Shoja MM, Helbig GM, Leipzig TJ, et al. Outcomes for clip ligation and hematoma evacuation associated with 102 patients with ruptured middle cerebral artery aneurysms. World Neurosurg 2013;80:335-41.
• 11 Gomis P, Rousseaux P, Jolly D, Graftieaux JP. Initial prognostic factors of aneurysmal subarachnoid hemorrhage. Neurochirurgie 1994;40:18-30.
• 12 Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, et al. Risk factors for subarachnoid hemorrhage: An updated systematic review of epidemiological studies. Stroke 2005;36:2773-80.
• 13 Orakdogen M, Emon ST, Somay H, Engin T, Ates O, Berkman MZ. Prognostic factors in patients who underwent aneurysmal clipping due to spontaneous subarachnoid hemorrhage. Turk Neurosurg 2016;26:840-8.
• 14 Chiang VL, Claus EB, Awad IA. Toward more rational prediction of outcome in patients with high-grade subarachnoid hemorrhage. Neurosurgery 2000;46:28-35.
• 15 Vergouwen MD, Ilodigwe D, Macdonald RL. Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects. Stroke 2011;42:924-9.
• 16 Shiue I, Arima H, Hankey GJ, Anderson CS. Location and size of ruptured intracranial aneurysm and serious clinical outcomes early after subarachnoid hemorrhage: A population-based study in Australasia. Cerebrovasc Dis 2011;31:573-9.
• 17 Orz Y, AlYamany M. The impact of size and location on rupture of intracranial aneurysms. Asian J Neurosurg 2015;10:26-31.
• 18 Forget TR Jr., Benitez R, Veznedaroglu E, Sharan A, Mitchell W, Silva M, et al. A review of size and location of ruptured intracranial aneurysms. Neurosurgery 2001;49:1322-5.
• 19 Joo SW, Lee SI, Noh SJ, Jeong YG, Kim MS, Jeong YT. What is the significance of a large number of ruptured aneurysms smaller than 7 mm in diameter? J Korean Neurosurg Soc 2009;45:85-9.
• 20 Lagares A, Gómez PA, Lobato RD, Alén JF, Alday R, Campollo J. Prognostic factors on hospital admission after spontaneous subarachnoid haemorrhage. Acta Neurochir (Wien) 2001;143:665-72.
• 21 Sandalcioglu IE, Schoch B, Regel JP, Wanke I, Gasser T, Forsting M, et al. Does intraoperative aneurysm rupture influence outcome? Analysis of 169 patients. Clin Neurol Neurosurg 2004;106:88-92.