Clinical Outcome of Intracranial Aneurysms:A Retrospective Comparison Between Endovascular Coiling and Neurosurgical Clipping

Endovascular coiling (EC) is being increasingly used as an alternative to surgical clipping (SC) for intracranial aneurysms, although the relative benefits of these two approaches have yet to be established. Purpose of this study was to review the anaesthetic and definitive management of patients with intracranial aneurysms in the interventional neuroradiology suite (INR) and compared with in the operation theatre. Retrospective review of first 100 consecutive patients in either mode of treatment (endovascular coiling and surgical clipping) was done. Data compared and analyzed included demographic profile, preoperative medical and surgical record, aneu-rysm characteristics, neurosurgical grading, intra and postoperative complications and clinical outcome at discharge from hospi-tal. P < 0.05 was considered significant. In INR group, aneurysms were located in both anterior and posterior circulation, but in SC group all they were in anterior circulation. There was no significant difference in Subarachnoid haemorrhage (SAH) grading in regards of Hunt and Hess and World Federation of Neurological Surgeons(WFNS). Clinical outcome at discharge was significantly better in patients treated with endovascular coiling as compared to surgical clipping(P = 0.042). We conclude that for the anaesthesiologist, one needs to be aware that the patient presenting for endovascular treatment may have more complex aneurysm anatomy and pathophysiology, premorbid systemic disorders (cardiac, respiratory renal) and may be older. In our study, overall outcome in patients who underwent endovascular coiling (in terms of Glasgow outcome scale) was significantly better then surgical clipping. In most of the time, whatever the complications occurred during the procedure were related to the procedure itself.