• Marcos Dellaretti, Daniel Ronconi, Danilo Malta Batista, Renata Ferreira de Souza, Almeida Carlos Eduardo Romeu de CER Department of Neurosurgery, Santa Casa de Belo Horizonte Hospital, Belo Horizonte, Minas Gerais, Brazil., Renato Rinco Fontoura, Paulo Ramos Botelho Antunes, and Ricardo Sousa Quadros.
• Department of Neurosurgery, Santa Casa de Belo Horizonte Hospital, Belo Horizonte, Minas Gerais, Brazil.
• World Neurosurg. 2018 Sep 1; 117: e580-e587.

BackgroundThe 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.MethodsThis 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.ResultsThe 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.ConclusionsMicrosurgical treatment of intracranial aneurysms is an effective and safe method.Copyright © 2018 Elsevier Inc. All rights reserved.

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