ABSTRACT
Objective: To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm
Study Design: Comparative study
Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013
Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society [WFNS] grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale [mRS] as favourable [mRS 2]
Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 +/- 10 years and in group B was 51.00 +/- 10 years. Overall, 56 [40%] males, 28 [60%] males in each group; and 84 [60%] females, 42 [60%] in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 [38.6%] patients had no disability [grades 1 and 2], 25 [35.7%] were slightly disabled [grade 3] and 18 [25.7%] had moderate disability [grade 4]; whereas in group B, i.e. clipping group 23 [32.9%] patients had no disability [grades 1 and 2], 23 [32.9%] were slightly disabled [grade 3] and 24 [34.3%] had moderate disability [grade 4]. At one year follow-up, in group A, favourable outcome was achieved in 56 [80%] of patients compared to 48 [68.6%] in group B; whilst, 14 [20%] patients in group A and 22 [33.1%] in group B showed unfavourable outcome. Although mortality rate was higher in clipping [n=3, 4.3%] as compared to coiling [n=1, 1.4%], but was not statistically significant [p = 0.310]
Conclusion: Endovascular coiling of anterior circulation aneurysms is safe and as effective and successful as aneurysm clipping and is less invasive also