Introduction: There are no large scale studies of ruptured wide neck aneurysms (WNAs) treated with microsurgical clipping.
Methods: This is a retrospective review of ruptured saccular WNAs treated by the senior author. From a database of 762 ruptured aneurysms treated by clipping from 2005 to 2016, 118 consecutive patients were screened. WNAs were defined as those with an absolute neck width of 4mm or greater or a dome-to-neck ratio (either height-to-neck or width-to-neck) less than 2. Of these, 34 were excluded for atypical aneurysm morphology (e.g fusiform) or incomplete angiographic data. Angiographic and clinical outcomes were assessed.
Results: After exclusion criteria were applied, 65 patients (55%) remained for analysis. Locations included ACom (n=25), MCA (n=13), ICA-PCom (n=11), basilar tip (n=7), ICA-other (n=6), PICA (n=2), and pericallosal (n=1). The majority of patients (75%) presented with good clinical grade (Hunt Hess 1-3). Sixty patients had postoperative angiographic examination, of which 98% had complete or near-complete aneurysm occlusion. At discharge, 37% of patients had a good outcome (mRS 0-2). Nine patients died before discharge, of which 8 presented with a high grade SAH. Forty-two patients had follow-up, of which 72% had a good clinical outcome.
Conclusions: Microsurgical clipping of ruptured WNAs results in excellent angiographic outcomes with the high rates of clinical improvement at follow-up. This data set will ultimately yield approximately 419 WNAs and may serve as an important comparison for the numerous studies evaluating the various endovascular technologies used to treat WNAs.
Patient Care: Our research may demonstrate that instances when microsurgical clipping is best for ruptured wide neck aneurysms and impact future decision making in patient care.
Learning Objectives: To understand the outcomes of microsurgical clipping of ruptured wide neck aneurysms as a comparison to the many endovascular studies of the same.