Safety of microsurgical treatment of intracranial aneurysms in a less developed country

Background: Nowadays, the use of microsurgery for clipping aneurysms has decreased considerably.

Objective: To demonstrate the safety of surgical treatment of intracranial aneurysms even in less developed countries.

Methods: Retrospective review of medical records of 320 patients with 416 aneurysms treated with microsurgical clipping from 2008–2016 in a single neurosurgical center in Brazil. This study evaluated postoperative evolution (using the modified Rankin Scale – mRS – prior to hospital discharge), and mortality.

Results: Among 320 patients with aneurysms, 228 patients presented with ruptured aneurysms and 92 patients with unruptured aneurysms. Overall, 81 (26,3%) presented poor evolution (mRs > 2) while 227 (73,4%) showed good evolution. The presence of ruptured aneurysm was a statistically significant factor for poor evolution (p < 0,001) and mortality (p < 0,015). Giant and large aneurysms were also associated with bad evolution (p = 0,004). When we analyze separately, unruptured aneurysms had poor evolution associated only with size of the aneurysms. Of the patients with ruptured aneurysms, those with Hunt Hess (HH) > 2 on hospital admission showed unfavorable outcomes (p < 0,0001).

Conclusion: Microsurgical treatment of intracranial aneurysms is a safe method even in less developed countries.