An Institutional Experience with Microsurgical Clipping of 170 Consecutive Cases of Intracranial Aneurysms: A Retrospective Data Analysis of Personal Cases

Due to advancements in technology, endovascular techniques (EVT) are considered a mainstay of treatment for intracranial aneurysms. However, for patients with anatomically complex aneurysms, associated intracranial hematomas requiring evacuation still need an open surgical clipping as the first line of treatment. Microsurgical clipping is an alternative for patients who cannot afford the high cost of EVT treatment.
This paper presents our experience in surgical clipping of symptomatic intracranial aneurysms performed in our hospital from Jan 2010 to Dec 2013 on 170 patients. Based on the data, this study recommends microsurgical clipping as a viable and cost effective option for symptomatic intracranial aneurysms.
Patients and This study was a retrospective analysis of case records of patients who had been treated for symptomatic intracranial aneurysms, including both ruptured and unruptured intracranial aneurysms, at Krishna institute of medical sciences from January 2010 to December 2013. A total of 230 patients, who had clinical and radiological evidence of symptomatic intracranial aneurysms, were admitted into the study. Of the total number of patients, 170 had been managed with microsurgical clipping. The patient’s demographics, the features of the aneurysms, clinical grades, cost effectiveness, and outcomes were analyzed. Excluded from the study were 60 patients who had been treated with the endovascular technique.
Of a total of 170 patients who underwent surgical clipping, 158 (93%) patients had an aneurysm in the anterior circulation and 12 (7%) in the posterior circulation. In the study group, 160 (94%) patients survived and 10 (6%) patients expired. One patient (0.58%) in the clipping group had a rebleed, and 4 (6.6%) patients from the coiling group eventually underwent clipping due to failed coiling. The average duration of hospital stay for the study group was 13 days and the cost for the treatment was Rs 2, 89, 238. The reasons for clipping in our patients were complex aneurysmal anatomy, difficulty accessing the aneurysm and MCA location in 60 (35%) patients, cost factor in 72 (42%) patients, non-availability of endovascular operator and hardware in 17 (10%) patients, associated hematoma requiring evacuation in 17 (10%) patients, and failure of the endovascular technique in 4 (2.5%) patients. Regarding outcomes, 83% of patients experienced a good outcome and 17% experienced a bad outcome.
These observations suggested that microsurgical clipping is a viable and cost effective alternative in the management of intracranial aneurysms in this endovascular era.