Results of Microsurgical Clipping of Anterior Circulation Aneurysms Secondary to Subarachnoid Hemorrhage: 107 Cases

Objective: Spontaneous subarachnoid hemorrhage (sSAH) is a significant disease requiring urgent intervention. It may develop because of the rupturing of intracranial aneurysms and has high mortality and morbidity rates. This study was conducted at a hospital that serves as a reference center in the region in which it is located with the aim of evaluating patient characteristics, patient preferences, and complication management among patients with aneurysmal subarachnoid hemorrhage (aSAH) and presenting the results of these intracranial aneurysm clipping surgeries.Methods: Cases of 261 patients who were admitted with a diagnosis of sSAH were retrospectively examined. Subsequently, 107 patients with aSAH who were treated with 117 microsurgical aneurysm clippings were included in the study. The effects of patient demographics, Glasgow coma scale (GCS) scores, clinical World Federation of Neurological Surgeons scale and Hunt/Hess scale scores, and radiological modified Fisher scale gradings on modified Rankin scale (mRS) scores were examined. The management of complications such as rebleeding, cerebral vasospasm (CV), and delayed cerebral ischemia and surgical results were compared according to clinical and radiological data.Results: Of the patients, 52 were female (48%) and 55 were male (52%). Their average age was 50.4 years (range: 29-78 years), and the mean follow-up period was 13.8 months or 414 days (range: 30-892 days). The most common complaint of the patients at admission was headache (75.8%). Approximately 72.9% of patients had GCS scores of 14 or 15 at first admission. Twenty-eight (26.1%) patients had multiple aneurysms. Thirteen (12%) patients required a permanent cerebrospinal fluid drainage system. Rebleeding occurred in 7 (6.5%) patients before treatment. Thirty-six (33.6%) patients had a clinical CV. Delayed cerebral ischemia occurred in 25 (23.3%) patients. At the end of the mean follow-up period of 13.8 months, 82.3% of the patients had slight or no disabilities (mRS: 0-2), whereas 11.2% had severe disabilities (mRS: 3-5). Seven (6.5%) patients died, thus having an mRS score of 6 (exitus). Five (4.6%) patients had residual aneurysms. Six (5.6%) patients had parent or perforating artery occlusion.Conclusion: Poor prognosis at admission, rebleeding, and CV complications remain the most important causes of mortality and morbidity related to aSAH. Evaluations of the diagnoses, treatments, and complication management of patients with sSAH and the multidisciplinary approaches of experienced endovascular and neurosurgical teams are important for better understanding and management of this disease.