Endovascular Treatment and Microsurgical Clipping for Intracranial Aneurysms: A Comprehensive Comparative Study

Intracranial aneurysms pose significant challenges due to their potential to rupture, leading to subarachnoid hemorrhage (SAH) with severe neurological consequences. Endovascular treatment has emerged as a minimally invasive alternative to surgical clipping, offering distinct advantages in terms of morbidity and recovery. This study aims to compare the clinical profiles, treatment outcomes, and prognostic factors between microsurgical clipping and endovascular treatment in the management of intracranial aneurysms.

This study analyzed 103 patients treated for intracranial aneurysms at a tertiary care institution in North India between January 2018 and December 2023. Of these, 53 underwent microsurgical clipping and 50 underwent endovascular treatment. Data on demographics, clinical presentations, aneurysm characteristics, and treatment details were meticulously collected. Immediate and long-term outcomes, including neurological status and complications, were assessed. Statistical analyses, including Chi-square tests and t-tests, were used to identify significant predictors of poor outcomes.

The mean age was 52.43 years for the clipping group and 54.42 years for the endovascular treatment group, with no significant difference (P = 0.951). The most common clinical presentations were headache and altered sensorium, with similar frequencies in both groups. Anterior communicating artery aneurysms were the most common location in both cohorts. The mean duration of operation was significantly longer for clipping (120.5 ± 30.6 min) compared to endovascular treatment (68.53 ± 25.23 min, P < 0.001). Postoperative complications were higher in the clipping group, including vasospasm (22.6% vs. 38.0%, P = 0.090) and cerebral infarcts (22.6% vs. 20.0%, P = 0.741). Endovascular treatment patients had a shorter hospital stay (18.30 ± 9.40 days vs. 27.55 ± 22.43 days, P = 0.162).

Both endovascular treatment and microsurgical clipping are effective treatment modalities for intracranial aneurysms, each with distinct advantages. Endovascular treatment offers a less invasive approach with shorter hospital stays and potentially better long-term outcomes. Microsurgical clipping provides durable aneurysm occlusion and remains critical for complex aneurysms. The choice of treatment should be individualized based on aneurysm characteristics, patient condition, and available expertise.