Abstract
BackgroundAnterior communicating artery (AComA) aneurysm rupture is the most common cause of subarachnoid hemorrhage worldwide. In this study, we aimed to determine the factors associated with a poor clinical outcome in patients with ruptured AComA aneurysms undergoing microsurgical clipping.MethodsWe retrospectively reviewed the clinical and radiologic features as well as clinical outcomes of 150 consecutive patients with ruptured AComA aneurysm who underwent surgical clipping during the 11-year study period. Logistic regression analysis was performed to identify independent factors associated with unfavorable clinical outcomes (defined as a modified Rankin scale score of 3–6).ResultsThe study included 83 male and 67 female patients, with a mean age of 51.3 ± 11.5 years. At admission, most of the patients had good neurological status, including 97 (64.7%) patients with a Hunt and Hess grade of 1 or 2 and 109 (72.6%) patients with a World Federation of Neurosurgical Societies grade of 1 or 2. Unfavorable outcomes at 6 months were observed in 23 (22.0%) patients, and the 6-month mortality rate was 8.0%. Multivariate analysis showed that preoperative intraventricular hemorrhage (odds ratio [OR], 19.66; 95% confidence interval [CI], 5.10–75.80; P < 0.001), A1 hypoplasia (OR, 8.90; 95% CI, 2.82–28.04; P < 0.001), and postoperative cerebral infarction (OR, 3.21; 95% CI, 1.16–8.88; P = 0.025) were strong independent risk factors for unfavorable outcomes.ConclusionsProper management of preoperative intraventricular hemorrhage, A1 hypoplasia, and intensive care for postoperative brain infarction are warranted for improved surgical outcomes in patients with ruptured AComA aneurysm undergoing surgical clipping.
Highlights
Anterior communicating artery (AComA) aneurysm rupture is the most common cause of subarachnoid hemorrhage worldwide
Microsurgical clipping remains the mainstay of treatment for aneurysms in this area because ruptures recur at a low rate and few subsequent treatments are needed following clipping [5]
Patients and aneurysm characteristics We performed microsurgical clipping in 420 patients with ruptured intracranial aneurysms, of which 150 (35.7%) had ruptured AComA aneurysms
Summary
Anterior communicating artery (AComA) aneurysm rupture is the most common cause of subarachnoid hemorrhage worldwide. Morbidity rates are still high [6, 7], primarily due to the complexity and anatomical variations of blood vessels at the surgical site Advanced surgical strategies, such as the skull-base technique, revascularization, or a combination of these along with endovascular treatments, might enable us to overcome these complexities [8]. Those treatments cannot always be performed, in low- to middle-income countries, because they require sophisticated medical resources
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