Outcome of intracranial aneurysm clipping: analysis of first 35 cases

Abstract

Background: Sub arachnoid hemorrhage due to ruptured intracranial aneurysm is a major healthcare concern because of its fatal consequence and also the potential to be fully treated if acted upon on time. The need for surgical expertise and robust perioperative intensive care remains an essential component for a good outcome. This study looks at the role of different constant and variable factors in the outcome of patients undergoing surgical clipping of aneurysm. Methods: A retrospective analysis of first 35 cases of spontaneous SAH due to ruptured intracranial aneurysms who underwent craniotomy and clipping were included in this study. Patients were divided into good outcome and poor outcome groups based on Modified Rankin scale at 2 weeks and 6 months postoperatively. Other details obtained included Modified Fisher Grade of SAH, presence or absence of vasospasm, site of aneurysm and size of aneurysm (largest diameter). Results: Good outcome modified Rankin score was 74.3% at 2 weeks postop, which increased to 80% at 6 months postoperatively. Variables which were found to have a statistically significant impact on the postoperative outcome were Modified Fisher grade, preoperative WFNS grade, duration of temporary clip placement, time of ictus to surgery, side of the aneurysm [left or right] and presence of hydrocephalus . Conclusions: Surgical clipping is a safe and time-tested modality for treatment of sub arachnoid hemorrhage due to ruptured intracranial aneurysms. Elderly age group, higher modified Fisher grades, higher WFNS Grade preoperatively, larger size of aneurysm, presence of vasospasm and greater duration of temporary clip placement are factors, which lead to poor outcome in patients with ruptured intracranial aneurysm presenting with sub arachnoid hemorrhage.