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

Introduction: Historically, microsurgical clipping has been the only treatment option for intracranial aneurysms. With the advent of endovascular coil occlusion, aneurysmal treatment strategies have significantly expanded. Endovascular techniques have led to a decline in the use of microsurgical techniques in the treatment of intracranial aneurysms over the past 20 years, despite a lack of clear evidence supporting this transition in all cases1. The literature provides corroboration that surgical clipping has excellent durability and most aneurysms can be successfully treated with open surgery. The effectiveness of surgical treatment of intracranial aneurysms has been assessed by numerous studies. However, as most of them were conducted in Europe and the USA, outcomes in less developed countries are not necessarily similar. There are few studies related to this issue in countries like Brazil, thus the purpose of this study was to evaluate the results of patients submitted to intracranial aneurysm clipping in a Brazilian public center of vascular neurosurgery.

Objective: To demonstrate the effectiveness 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. The efficacy of treatment was evaluated by digital subtraction angiography (DSA) performed postoperatively and the patients were subdivides in two groups; complete and incomplete occlusion.

Results: Among 320 patients with 416 aneurysms treated, 231 were submitted to DSA post operatively. Among those, 207 (89.8%) showed complete occlusion of the aneurysms, while 24 (10.2%) patients presented residual aneurysm, and reoperation was required in eight cases (one third of residual neck aneurysms, and 3.5% of all aneurysms).

Conclusion: Microsurgical treatment of intracranial aneurysms is an effective method even in less developed countries.

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