• World Neurosurg · Oct 2019

    Surgical outcomes and their correlation to increasing surgical experience in a series of 250 ruptured or unruptured aneurysm undergoing microsurgical clipping.

    • Alberto Tomatis, Gianluca Trevisi, Beatrice Boido, Rosa Perez, and Carlo Alberto Benech.
    • Neurosurgical Unit, Ospedale Spirito Santo, Pescara, Italy. Electronic address: albertotommy.tomatis@gmail.com.
    • World Neurosurg. 2019 Oct 1; 130: e542-e550.

    BackgroundThe development of endovascular techniques has offered extraordinary therapeutic opportunities to treat intracranial aneurysms. However, mainly for anterior circulation aneurysms, no clear superiority of these techniques compared with microsurgical clipping has been shown in terms of morbidity, mortality, aneurysm occlusion rate, and long-term protection from recanalization and rebleeding. We reviewed the data from a retrospective case series to determine the clinical and radiological outcomes of clipped ruptured and unruptured aneurysm to analyze the relationship between increasing surgical experience and operative time, recovery time, and clinical outcomes.MethodsA total of 250 consecutive aneurysms in 221 patients had been treated from June 2009 to June 2015. The postoperative complications, recovery time (only for the unruptured group), operative time, clinical outcomes, and aneurysm occlusion rate at 3 months were analyzed for both ruptured and unruptured aneurysms. Linear regression was used to analyze the relationship between surgical experience and the operative time, recovery time, and clinical outcomes.ResultsThe complication rate was very low in the unruptured cases (117 patients), with 100% of patients in good clinical status at 3 months. In the ruptured cases (104 patients), the presenting neurological status significantly influenced the postoperative outcomes. Complete obliteration found on the 3-month digital subtraction angiogram was obtained for 96.6% of the treated aneurysms in both groups. A significant correlation was found between surgical experience and both the operative time and recovery time.ConclusionsIn a subset of patients (aneurysm located in the anterior circulation and <12 mm), microsurgical clipping appeared to be as safe as endovascular treatment and can obtain a very high complete occlusion rate. Increasing surgical experience improved the operative time and recovery time, with a trend toward improvement of the clinical outcomes.Copyright © 2019 Elsevier Inc. All rights reserved.

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