Outcome Determinant of Patients Following Microsurgical Clipping of Ruptured Intracranial Aneurysms.

Abstract

Objectives  Numerous factors can influence patient outcomes following microsurgical clipping of intracranial aneurysms (IAs). Some unique factors, such as aneurysm surgery during the COVID-19 pandemic, also play a role. This study aims to evaluate outcomes in patients with ruptured IAs undergoing microsurgical clipping and identify predictors for both immediate and long-term prognosis. Materials and Methods  This is a retrospective study with prospectively collected data of 500 patients with ruptured aneurysms undergoing microsurgical clipping over a period of 10 years (April 2011-November 2022). The follow-up period ranged from 2 to 10 years, and clinical outcomes were evaluated using the Glasgow Outcome Scale (GOS). Data were analyzed using STATA version 3.10. Logistic regression was used to calculate p -values, with a significance level of p  < 0.05. Results  Among 500 patients treated for ruptured IAs, 169 were males and 331 were females, with a median age of 53 years. Postoperative vasospasm was a major predictor of worse outcomes at discharge ( p  < 0.001), 6 months ( p  < 0.001), 1 year ( p  < 0.001), 5 years ( p  = 0.014), and 10 years ( p  = 0.006). Patients treated during the COVID-19 pandemic had worse outcomes at 6 months ( p  < 0.001) and 1 year ( p  = 0.001). Conclusion  Postoperative vasospasm, intraoperative rupture, and the COVID-19 pandemic were the most important predictors of worse outcomes. Factors such as age, hospital type, Miller Fisher grade, alcohol abuse, diabetes, aneurysm multiplicity, aneurysm size, neck size, ethnicity, hydrocephalus, brain retraction, and lamina terminalis fenestration did not significantly influence the outcomes.