International Journal of Advances in Medicine | April-June 2015 | Vol 2 | Issue 2 Page 88 International Journal of Advances in Medicine Nayak MT et al. Int J Adv Med. 2015 May;2(2):88-93 http://www.ijmedicine.com pISSN 2349-3925 | eISSN 2349-3933 Research Article Outcome of intracranial aneurysm clipping: analysis of first 35 cases Madhukar T. Nayak 1 *, Vidyashri Kamath 2 INTRODUCTION Sub arachnoid hemorrhage due to ruptured intracranial aneurysm is a major healthcare concern because of its fatal consequence and also the potential to be fully treated if acted upon on time. It constitutes 85% of non- traumatic SAH cases. 1 The incidence of intracranial aneurysms have been found to be as high as 1% in males and 2% in females in the UK. 2 Although the incidence of patients presenting with routine headache, later found to have ruptured intracranial is very less, strikingly around 10% of patients who were otherwise intact, but had “severe and worst headache of their life”, on further workup were found to have a ruptured intracranial aneurysm. 3 In the recent decades, advances in micro neurosurgical techniques, clear understanding of 3 dimensional neurovascular anatomy and availability of tools for intraoperative evaluation of accuracy of the procedure (intraoperative indocyanine green angiogram, microvascular Doppler and conventional intraoperative angiography) have contributed in making this treatment modality safer and more favorable. The need for surgical ABSTRACT Background: Sub arachnoid hemorrhage due to ruptured intracranial aneurysm is a major healthcare concern because of its fatal consequence and also the potential to be fully treated if acted upon on time. The need for surgical expertise and robust perioperative intensive care remains an essential component for a good outcome. This study looks at the role of different constant and variable factors in the outcome of patients undergoing surgical clipping of aneurysm. Methods: A retrospective analysis of first 35 cases of spontaneous SAH due to ruptured intracranial aneurysms who underwent craniotomy and clipping were included in this study. Patients were divided into good outcome and poor outcome groups based on Modified Rankin scale at 2 weeks and 6 months postoperatively. Other details obtained included Modified Fisher Grade of SAH, presence or absence of vasospasm, site of aneurysm and size of aneurysm (largest diameter). Results: Good outcome modified Rankin score was 74.3% at 2 weeks postop, which increased to 80% at 6 months postoperatively. Variables which were found to have a statistically significant impact on the postoperative outcome were Modified Fisher grade, preoperative WFNS grade, duration of temporary clip placement, time of ictus to surgery, side of the aneurysm [left or right] and presence of hydrocephalus. Conclusions: Surgical clipping is a safe and time-tested modality for treatment of sub arachnoid hemorrhage due to ruptured intracranial aneurysms. Elderly age group, higher modified Fisher grades, higher WFNS Grade preoperatively, larger size of aneurysm, presence of vasospasm and greater duration of temporary clip placement are factors, which lead to poor outcome in patients with ruptured intracranial aneurysm presenting with sub arachnoid hemorrhage. Keywords: Cerebral aneurysm, Sub arachnoid hemorrhage, Overall outcome, Vasospasm, Aneurysm clipping 1 Department of Neurosurgery, 2 Department of Obstetrics and Gynaecology, Father Muller Medical College, Mangalore, Karnataka, India Received: 23 February 2015 Accepted: 28 February 2015 *Correspondence: Dr. Madhukar T. Nayak, E-mail: madhukar1978@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: 10.5455/2349-3933.ijam20150501