Safety and Efficacy of Surgical Treatment of Intracranial Aneurysms: The Experience of a Single Brazilian Center

• Published in: World neurosurgery Vol. 117; pp. e580 - e587
• Main Authors: Dellaretti, Marcos, Ronconi, Daniel, Batista, Danilo Malta, Ferreira de Souza, Renata, Almeida, Carlos Eduardo Romeu de, Fontoura, Renato Rinco, Antunes, Paulo Ramos Botelho, Quadros, Ricardo Sousa
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2018
• Subjects: Cerebral aneurysm; Clip; Endovascular; Hunt and Hess; Microsurgery; Modified Rankin Scale; Outcome; HH; Cerebral aneurysm; Endovascular; mRS; Clip; DSA; Modified Rankin Scale; Outcome; Microsurgery; SAH; BRAT; Hunt and Hess; ISAT
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.06.091

The use of microsurgery for aneurysm clipping has decreased considerably in recent years. This study was conducted to demonstrate the safety and effectiveness of surgical treatment of intracranial aneurysms even in less-developed countries. This study was a retrospective review of the medical records of 320 patients with 416 aneurysms treated with microsurgical clipping at a single neurosurgical center in Brazil between 2008 and 2016. We evaluated postoperative outcomes using the modified Rankin Scale (mRS) at the time of hospital discharge, treatment efficacy by digital subtraction angiography (DSA) performed postoperatively, and mortality. The 320 patients with aneurysms included 228 patients with ruptured aneurysms and 92 with unruptured aneurysms. Overall, 81 (26.3%) had a poor outcome (mRS score >2), and the other 227 (73.4%) had a good outcome. The presence of a ruptured aneurysm was a statistically significant factor for poor outcome (P < 0.001) and mortality (P < 0.015). Giant and large aneurysms were also associated with poor outcome (P = 0.004). When analyzed separately, unruptured aneurysms with poor outcome were only associated with aneurysm size. Among the patients with ruptured aneurysms, those with Hunt and Hess (HH) grade >2 on hospital admission had unfavorable outcomes (P < 0.0001). Among the patients who underwent postoperative DSA, 207 (89.8%) had complete aneurysm occlusion and 24 (10.2%) had residual aneurysms, with reoperation required in 8 cases. Microsurgical treatment of intracranial aneurysms is an effective and safe method. •Surgical clipping remains an excellent option for treating cerebral aneurysms.•Overall, ruptured and large aneurysms are associated with poor outcome.•For unruptured aneurysms, only size is linked with evolution.•For ruptured, initial Hunt and Hess grade was a factor in poor prognosis.•Nearly 90% of aneurysms showed complete occlusion.