title: Surgical outcome of primary clipping for anterior circulation aneurysms of size 2 centimeters or larger.
abstract: BACKGROUND
  Aneurysms of the anterior circulation larger than 2cm have a complex relationship to the anterior skull base, requiring a multi-modality management approach. This retrospective study of 54 patients with such aneurysms who underwent clipping between 2001 and 2012 analyzes clinical and surgical data, aneurysm characteristics and correlates them with respect to the Glasgow outcome score at follow-up and immediate post-operative clinical status.
  
  
  METHODS
  Patients with an outcome score of 5 or 4 were categorized as "good", while those with score 3-1 were "poor". Fisher's exact test and paired T-test (p<0.5) were used to test statistical significance for discrete and continuous variables respectively.
  
  
  RESULTS
  44 (81.4%) patients had a good outcome. Patients with non-ophthalmic/paraclinoid aneurysms had significantly lower incidence of adverse intra-operative events (p=0.035). Patients older than 50 years (p=0.045), with adverse intra-operative events (p=0.015) and post-operative infarction (p<0.001) had a poor outcome compared to those younger than 50 years age and those without adverse intra-operative events or infarctions. The grouped age variable had maximum influence on patient outcome. Location and size of aneurysm did not have an overall impact on surgical outcome. There were 4 mortalities.
  
  
  CONCLUSIONS
  Primary clipping of proximal non-cavernous aneurysms on the internal carotid artery is associated with adverse intra-operative events. A multi-modality treatment approach in these aneurysms should be individualized, more so in patients older than 50 years.
authors.affiliation: Department of Neurosurgery, Sri Sathya Sai Institute Of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, India. Electronic address: sunilvf@gmail.com.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Furtado
authors.affiliation: Department of Neurosurgery, Sri Sathya Sai Institute Of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, India.
authors.forename: Narayanam A
authors.initials: NA
authors.lastname: Saikiran
authors.affiliation: Department of Neurosurgery, Sri Sathya Sai Institute Of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Thakar
authors.affiliation: Department of Neurosurgery, Sri Sathya Sai Institute Of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Dadlani
authors.affiliation: Department of Neurosurgery, Sri Sathya Sai Institute Of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, India.
authors.forename: Dilip
authors.initials: D
authors.lastname: Mohan
authors.affiliation: Department of Neurosurgery, Sri Sathya Sai Institute Of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, India.
authors.forename: Saritha
authors.initials: S
authors.lastname: Aryan
authors.affiliation: Department of Neurosurgery, Sri Sathya Sai Institute Of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, India.
authors.forename: Alangar S
authors.initials: AS
authors.lastname: Hegde
mesh_terms: D000367:Age Factors; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anterior circulation; Clipping; Giant aneurysm; Intracranial hemorrhage; SAH