title: Aneurysmal Subarachnoid Hemorrhage: Outcome of Aneurysm Clipping Versus Coiling in Anterior Circulation Aneurysm.
abstract: OBJECTIVE
  To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm.
  
  
  METHODS
  Comparative study.
  
  
  METHODS
  Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013.
  
  
  METHODS
  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 ) and unfavourable (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 Aand 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).
  
  
  CONCLUSIONS
  Endovascular coiling of anterior circulation aneurysms is safe and as effective and successful as aneurysm clipping and is less invasive also.
authors.affiliation: Department of Neurosurgery, Lahore General Hospital, Lahore.
authors.forename: Ijaz Hussain
authors.initials: IH
authors.lastname: Wadd
authors.affiliation: Department of Neurosurgery, Lahore General Hospital, Lahore.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Haroon
authors.affiliation: Department of Neurosurgery, Lahore General Hospital, Lahore.
authors.lastname: Habibullah
authors.affiliation: Department of Neurosurgery, Lahore General Hospital, Lahore.
authors.forename: Safroz
authors.initials: S
authors.lastname: Ansari
authors.affiliation: Department of Neurophysician, Lahore General Hospital, Lahore.
authors.forename: Shahid
authors.initials: S
authors.lastname: Mukhtar
authors.affiliation: Department of Neuro Radiology, Lahore General Hospital, Lahore.
authors.forename: Umair
authors.initials: U
authors.lastname: Rashid
authors.affiliation: Department of Neurosurgery, Lahore General Hospital, Lahore.
authors.forename: Anjum Habib
authors.initials: AH
authors.lastname: Vohra
mesh_terms: D000293:Adolescent; D000328:Adult; D017542:Aneurysm, Ruptured / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000601:surgery / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult