Abstract
Objectives: To analyze the management and outcome of ruptured anterior cerebral circulation aneurysm by a variety of procedures including microsurgical clipping.
 Material and Methods: A quasi-experimental study, carried out in The Department of Neurosurgery, Peoples’ Medical University Hospital Nawabshah from November 2010 to December 2020.We enrolled 38 patients and 40 aneurysms who presented with ruptured aneurysms. Hunt and Hess grading was used to evaluate the neurological status and ruptured aneurysms were managed by microsurgical clipping, excision, and suture ligation.
 Results: Out of 38 patients Male were (23) 61% and females were (15) 39%, with a mean age of 50±25 years with aneurysmal subarachnoid hemorrhage and graded according to Hunt and Hess grade and fissure grading. Middle cerebral artery aneurysm was 45%, Anterior communicating artery 30%, Anterior Cerebral Artery 10%, carotid bifurcation 2.5%. Multiple aneurysms at internal carotid plus anterior communicating artery (n = 2) and internal carotid plus middle cerebral artery aneurysms n = 2. Distal anterior cerebral (n = 1). In 33 patients, the aneurysm was clipped, in 3 patients with fissure grading 4 and huge intracerebral bleed with signs of brain herniation, decompression plus aneurysm clipping was done, suture ligation (n = 1) and excision of a giant aneurysm (n = 3).
 Conclusions: Microsurgical clipping is considered an ideal modality to secure a ruptured intracerebral aneurysm. Rarely it can be amendable by suture ligation, or excision. Presenting Hunt and Hess, fissure grading, age, and volume of intracerebral bleed have a direct impact on prognosis.
Highlights
A cerebral aneurysm is a life-threatening disease that can be defined as an abnormal dilation of the vessel wall.[1]
Anterior circulation aneurysm is approximately 85 to 90% and the commonest among that is anterior communicating posterior communicating followed by middle cerebral artery aneurysms.[8]
We found MCA aneurysm in 18, Acom (Anterior communicating Artery) in 12, and others
Summary
A cerebral aneurysm is a life-threatening disease that can be defined as an abnormal dilation of the vessel wall.[1] Most commonly encounter at the weakest or diseased layers of the vessel, where there is proximal branching or a sudden turn in the artery, indicates that hemodynamic stress plays a major role.[2] Generally accurate prevalence and incident is not possible due to cumulative factors including sudden and undiagnosed deaths without autopsy or radiological intervention. Aneurysmal intracranial subarachnoid hemorrhage is the most common neurosurgical emergency with the prevalence of about 6 – 10 in. 100,000 per annum.[3,4] A ruptured aneurysm is linked with high mortality and disability associated with a 30-day mortality of 35%, hardly. Mortality of 30to 50% who arrival at neuro-critical care is due to delayed ischemic even and rebreeding.[1,6] Development of an aneurysm is most likely due to congenital but certain hereditary, degenerative, connective tissue disorder, inflammatory, infectious even neoplastic disease has a vital role in the aneurysm formation.[6,7] Anterior circulation aneurysm is approximately 85 to 90% and the commonest among that is anterior communicating posterior communicating followed by middle cerebral artery aneurysms.[8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
