Surgical Outcomes of Anterior Circulation Aneurysm at Tertiary Care Center of Central India

Background: Aneurysm clipping, which was first reported by Walter Dandy in 1938, remains a reliable and efficient way of treating cerebral aneurysms. It focussed on the outcomes of microsurgical clipping in 51 patients with anterior circulation aneurysms. Aims and Objectives: The study aimed to evaluate the effectiveness of microsurgical clipping and identify factors associated with poor surgical outcomes, using the Modified Rankin Scale (mRS) to assess patient performance, with mRS ≥ 3 indicating poor performance. Results: The study found that the most common aneurysm location was the anterior communicating artery (AComA), with ruptured AComA aneurysms being the most prevalent. The patient demographics showed a nearly equal distribution of males and females, with a mean age of 50.21 years. There was no significant association between mRS and gender or age group, although patients over 60 years old had a higher rate of unfavorable outcomes. Radiological evaluations, including CT angiogram and DSA, were performed preoperatively. The most common radiological finding was subarachnoid hemorrhage (SAH), with intraventricular hemorrhage (IVH) and hydrocephalus also observed. The study noted a significant association between hematoma and poor outcomes but not between mRS and modified Fisher grade or radiological vasospasm. Comorbidities such as hypertension and diabetes were present in a significant portion of the study population, with hypertension being more common in poor-performing patients, although it did not reach statistical significance. Postoperative outcomes showed that 60.78% of patients achieved favorable outcomes at discharge, with a total of 9 deaths (17.64%) during the study period. Factors such as preoperative IVH, intracerebral hematoma, female sex, age over 60, hypertension, and postoperative cerebral infarct were significant prognostic indicators for unfavorable outcomes at 6 months. Conclusion: The study identified several factors that can influence the outcomes of microsurgical clipping for anterior circulation aneurysms, with the potential to inform clinical decision-making and patient management.