Factors Affecting Outcome in Surgically Clipped Ruptured Anterior Circulation Aneurysms – A Retrospective Analysis

Abstract

Abstract Introduction: Ruptured cerebral aneurysm is a life-threatening condition that requires urgent medical attention. Failure to diagnose, delay in admission to a neurosurgical centre and lack of facilities could lead to poor surgical outcomes. Aim: The purpose of this study was to identify the factors that predict the outcome of patients undergoing a surgical clipping of ruptured anterior circulation aneurysms. Materials and Methods: This was a single-centre retrospective study with review of medical records of 306 patients, who were surgically treated for ruptured intracranial aneurysms in a tertiary care centre from January 2011 to June 2018. Information collected were the patient demographic data, Glasgow Coma Scale prior to surgery, World Federation of Neurosurgical Societies Scale and timing between subarachnoid haemorrhage (SAH) ictus and surgery. The outcomes at discharge and 6 months post-surgery were assessed using the modified Rankin Scale (mRS). Only cases of proven ruptured aneurysmal SAH involving anterior circulation that underwent surgical clipping were included in the study. The data collected were analysed statistically. Results: The mean duration between ictus and time of surgery was found to be 9.89 days, maximum being 43 days. Patients with persisting disabilities (according to mRS) at the 1st month and 3rd month post-surgery had a mean duration of 16.69 and 16.95 days, from ictus to surgery. Conclusions: Delay in surgical clipping of anterior circulation aneurysms and poor grade at presentation were found to have unfavourable outcomes. Health education and training should be incorporated in primary healthcare setups regarding the identification of probable aneurysm rupture in early stage, so that prompt referral to higher centre can be carried out and delay in intervention be curtailed.