Long-term outcomes following the clipping of ruptured intracranial aneurysms of the anterior circulation: A retrospective institutional study

TL;DR

This study found that waiting 3 days before surgery for ruptured brain aneurysms in the anterior circulation leads to better long-term outcomes and lower mortality.

Contribution

The study provides evidence that delayed surgical clipping (after 3 days) improves outcomes in patients with ruptured anterior circulation aneurysms.

Findings

Mortality was significantly lower in patients who underwent surgery after 3 days compared to those operated within the first 3 days.

Delayed surgery was associated with better outcomes, including fewer complications and improved functional recovery.

Post-operative hemiplegia and mortality were independent factors affecting patient outcomes.

Abstract

Aneurysmal subarachnoid hemorrhage (SAH) constitutes a devastating and life-threatening neurosurgical emergency. Over a number of years, there has been a debate as regards the most suitable timing for surgery. The present retrospective study aimed to investigate the association between the timing of treatment and the outcomes of patients who underwent clipping of ruptured intracranial aneurysms. The present study performed a retrospective analysis of 92 of 142 consecutive patients who were diagnosed with anterior circulation ruptured aneurysms and treated only by microsurgical clipping between January, 2013 and December, 2018. The patients were divided into two groups, namely group A, which included patients who underwent microsurgical clipping for ruptured anterior circulation aneurysm in the early stages (within the first 3 days of aneurysm rupture occurrence), and group B, which included those who were operated on in the late stages (after 3 days of aneurysm rupture occurrence). The age of the patients ranged from 26 to 78 years, with a mean age of 54.6 years. In total, 52 patients were female (56.6%) and 40 patients were male (43.4%). Risk factors associated with a high incidence of rupture included hypertension in 47 (51.0%) patients, cigarette smoking in 39 (42.3%) patients, alcohol consumption in 20 (21.7%) patients and diabetes mellitus in 2 (2.1%) patients. The present study revealed that the mortality rate was lower in group B (P=0.011; 4.3% compared with 11.9% in group A). This indicates that particularly the timing of surgery in group B (patients who were operated on in the late stages, after 3 days of aneurysm rupture occurrence) was more appropriate. In addition, no complications, post-operative hemiplegia and mortality were all independent factors associated with good outcomes (≥2 modified Rankin scale) (P<0.05 for all three parameters). On the whole, the present study demonstrates that the outcomes of patients who underwent microsurgical clipping for ruptured anterior circulation aneurysms ≥3 days after admission or rupture occurrence, exhibited favorable outcomes compared to patients operated on during the first 2 days of occurrence.

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