Risk of Dependency Following Microsurgical Clipping in Good Grade Patients with Ruptured Anterior Circulation Aneurysms

It is well known that the majority of good grade (WFNS I and II) patients who undergo microsurgical clipping achieve a favorable outcome, but still a number of patients who are independent before surgery face unfavorable outcomes signifying the impact of microsurgical clipping. The aim of this study was to quantify the risk of dependency in patients who had no previous neurological deficit.

We reviewed 50 consecutive good grade patients with ruptured anterior circulation aneurysms who underwent microsurgical clipping between May 2017 and May 2020 in the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore. The clinical outcome at discharge and at 3 months follow-up was assessed using the Glasgow Outcome Scale (GOS).

In this study, seven patients (14%) were dependent (GOS II and III) following clipping. Out of this, five patients (10%) suffered surgical insult in the form of intraoperative rupture (4%), postop infarct (4%), and direct brain damage (2%).

Patients without neuro deficit preoperatively still suffer unfavorable outcome mainly due to operative insults. Vascular injuries remain the main cause of morbidity producing dependency. Therefore, it is essential to reiterate that all surgical techniques must be directed at minimizing the risk to vessels, both during dissection and at clip placement.