Surgical audit of ruptured intracranial anterior circulation aneurysm clipping in Neurosurgery Unit II, Punjab Institute of Neurosciences, Lahore.

Objective:To review and document the rates of morbidity and mortality after surgical clipping for ruptured intracranial anterior circulation aneurysms in the department of Neurosurgery Unit II at Punjab Institute of Neurosciences, Lahore. Methods:Retrospective observational study was done. Doctors’ and nurses ‘notes, and radiology were reviewed to analyze the outcome of patients after microsurgical clipping. Results:180 patients were included according to non-probability, consecutive sampling. Mean age = 44.32±13.75 years, male to female ratio of 2.05:1. Fisher grade was: Grade I – 89.4%, Grade II-6.7% and Grade III- 3.9%. WFNS grade was: Grade I- 83.9%, Grade II – 11.1%, Grade III – 1.7% and Grade IV – 3.3%. Hunt and Hess grade was: Grade I- 47.4%, Grade II-25%and Grade III- 0.6% (p=<0.001)(Confidence Interval-CI=95%). Anterior Communicating Artery aneurysms were 47.22 % (p=0.50), Middle Cerebral Artery aneurysms 28.3% (p<0.001), Internal Cerebral Artery aneurysms 8.9%(p<0.001), Distal Anterior Cerebral Artery aneurysm 8.3% (p<0.001) and Posterior Communication Artery aneurysms 7.2%(p<0.001). , A temporary clip was applied during surgery in 13.3% only.The results showed the incidence of these outcomes as: Acute New onset Neurological Deterioration/Deficit was documented in 6.1%), Rebleeding 3.3%, Vasospasm 5.0%, Revision surgery 6.1% and Mortality in 8.3% (p<0.001). Conclusion:T the outcome of patients who underwent surgical clipping of ruptured anterior circulation aneurysms in the department of Neurosurgery Unit II, Punjab Institute of Neurosciences, Lahore, is comparable to the results of the studies and trials in the published literature