Early postoperative deficits predict long-term outcome after clipping of ruptured MCA aneurysms

Background Recovery following microsurgical clipping of ruptured middle cerebral artery aneurysms is variable, and determinants of long-term outcome remain incompletely characterized. This study evaluated whether early postoperative neurological status and presenting hemorrhage patterns were associated with long-term functional recovery and the risk of delayed cerebral ischemia in patients undergoing microsurgical clipping of ruptured middle cerebral artery aneurysms. Methods A retrospective cohort of 67 consecutive patients undergoing clipping for ruptured middle cerebral artery aneurysm was analyzed. Primary outcome was poor functional status, defined as modified Rankin Scale >2 at 12 months. Immediate postoperative neurological deficits were defined as new or persistent focal neurological impairment documented on the first standardized neurological examination after recovery from anesthesia, typically postoperative day 0–1, and were analyzed as present or absent. Secondary outcomes included early recovery patterns and predictors of delayed cerebral ischemia. Exploratory regression modeling was used where event counts permitted; 12-month outcome analyses were interpreted descriptively because of limited follow-up and few outcome events. Results At 12 months, outcome data were available for 22 patients, of whom 3 patients (13.6%) had poor functional outcome. All poor 12-month outcomes occurred among patients with immediate postoperative neurological deficits, although 12-month analyses were descriptive because follow-up was limited. Intraventricular hemorrhage (OR 10.52) and postoperative deficits (OR 13.75) were associated with delayed cerebral ischemia. Intracerebral hemorrhage was associated with worse functional outcomes across time points. Conclusions Early postoperative neurological status was associated with long-term functional recovery after clipping of ruptured MCA aneurysms, although 12-month findings were limited by incomplete follow-up and few poor outcome events. Most observed improvements occurred within the first six months, with limited late gains. Hemorrhage patterns, particularly ICH, may help identify patients at higher risk of poor recovery, while IVH and postoperative deficits were associated with DCI in exploratory analyses.