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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Long-term outcome in surviving patients after clipping of intracranial aneurysms
Sunil Kumar Gupta1, Rajesh Chhabra1, Sandeep Mohindra1
1Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Surgical clipping for brain aneurysms leads to long-term functional improvement for most patients. However, a significant number experience lasting cognitive deficits, highlighting the need for continued monitoring.
Area of Science:
- Neurosurgery
- Neurology
- Public Health
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) can severely impact quality of life and functional outcomes.
- Surgical clipping is a primary treatment for intracranial aneurysms, but long-term results require thorough evaluation.
Purpose of the Study:
- To assess the long-term functional and cognitive status of patients after surgical clipping of intracranial aneurysms.
- To identify preoperative factors influencing patient outcomes following aneurysm treatment.
Main Methods:
- A cohort of 494 patients with intracranial aneurysms treated with surgical clipping and followed for at least 1 year post-discharge was analyzed.
- Preoperative data including age, Hunt and Hess grade, Fisher grade, ictus-surgery interval, and aneurysm site were collected.
- Long-term outcomes were evaluated using the Glasgow Outcome Scale (GOS), Modified Rankin Scale (MRS), Barthel Index (BI), and Mini-Mental State Examination (MMSE).
Main Results:
- Aneurysm site and ictus-surgery interval did not significantly affect long-term outcomes.
- Most patients showed continued improvement in functional status (GOS, MRS, BI) post-discharge.
- A significant proportion of patients exhibited impaired cognitive function (MMSE) in the long term.
- Multivariate analysis revealed age significantly impacted MMSE scores, and a higher number of aneurysms correlated positively with GOS.
Conclusions:
- Patients surviving and discharged after surgical clipping often experience sustained functional recovery.
- Despite overall improvement, a notable subset of patients faces persistent cognitive impairments.
- Age and the number of aneurysms are key factors influencing long-term neurological outcomes after surgical clipping.
Objective:
The quality of life and functional outcome may be significantly impaired in patients of aneurysmal subarachnoid hemorrhage. The purpose of the present study was to assess the status of patients undergoing surgical clipping of intracranial aneurysms in a long-term follow-up and to identify factors affecting outcome.
Methods:
494 patients who underwent clipping of their intracranial aneurysms with a minimum follow-up of 1 year after their discharge were studied. Preoperative factors such as age, Hunt and Hess grade, Fisher grade, time interval between ictus and surgery, and site of aneurysm were recorded. The long-term status was assessed using Glasgow Outcome Scale (GOS), Modified Rankin Scale (MRS), Barthel index (BI), and Mini-Mental State Examination (MMSE).
Results:
Site of aneurysm and ictus-surgery interval did not have any effect on any parameter at long-term follow-up. Majority of patients who were discharged continued to improve as measured by GOS, Modified Rankin Scale, and Barthel index. However a significant proportion of patients had impaired MMSE at long-term follow-up. Multivariate analysis showed a significant effect of age on MMSE and also a positive correlation between number of aneurysms and GOS.
Conclusions:
Most patients who survived and were discharged continued to improve in the postoperative period even though the immediate postoperative outcome was not favorable in many. However, a substantial subset had impaired cognitive function.
