Outcome Assessment In Patients With Anterior Circulation Intracranial Aneurysms Treated With Microsurgical Clipping - A Follow Up Study

Dr Ashish; Dr Paul Sudhakar John B; Dr Sarvpreet Singh Grewal; Dr Shivender Sobti

Volume : IX, Issue : VII, July - 2020

Outcome Assessment In Patients With Anterior Circulation Intracranial Aneurysms Treated With Microsurgical Clipping - A Follow Up Study

Dr Ashish, Dr Paul Sudhakar John B, Dr Sarvpreet Singh Grewal, Dr Shivender Sobti

Abstract :

BACKGROUND: Aneurysms of the cereal vasculature is a Common Devastating neurosurgical problem. They become problematic after rupture leading to parenchymal haemorrhage, or more often subarachnoid haemorrhage (SAH). The focus of this study is aneurysms in the region of anterior communicating artery (Acom), the intracranial part of internal carotid artery aneurysm (ICA) and the middle cereal artery (MCA). Multiple preoperative, intraoperative and postoperative parameters and events that influence the surgical outcome of these aneurysms. MATERIALS AND METHODS: In this study, 65 patients with anterior circulation intracranial aneurysms who were operated were studied to compare surgical outcome. Multiple pre-operative, intra-operative and post-operative factors were studied. Follow up was done at 3 and 6 months and functional independence of the patient was assessed using Glasgow outcome score(GOS). RESULTS- Patients with higher Fischer�s grade was seen to have higher chances of postoperative vasospasm. In our series 33 i.e. 50.77% patients had some degree of hydrocephalus preoperatively whereas only 15 i.e. 23.08% patients needed CSF shunting postoperatively. n=9 (13.84%) patients underwent re-exploration in the post op period and n= 7 (10.8%) had poor GOS score of 1 at 3 and 6 months. CONCLUSION- The postoperative parameters which significantly correlated with poor GOS score at 3 months and 6 months of follow up were vasospasm, postoperative infarct, ventilatory support duration, GCS on POD 2 of < 15 & ICU stay duration > 7 days, associated intraventricular/parenchymal bleed, need for CSF diversion, and need for re-exploration. The outcome did not significantly depend on patient�s age, gender, location of aneurysm, timing for surgery i.e. interval between SAH and surgery, method of securing aneurysms, intraoperative method of securing the aneurysm.