title: Microsurgical Clipping of Unruptured Intracranial Aneurysms: A Single Surgeon's Experience over 16 Years.
abstract: BACKGROUND
  Unruptured intracranial aneurysms (UIAs) have become an issue of greater significance as their detection rates have increased over the years. We present the overall experience of microsurgical clipping of unruptured aneurysms by a single surgeon over a period of more than 16 years.
  
  
  METHODS
  The clinical and radiologic data were reviewed retrospectively. Clinical outcome at follow-up was assessed with Glasgow Outcome Scale, and angiograms were reviewed for the degree of occlusion.
  
  
  RESULTS
  One hundred ninety-six patients with 221 UIAs were included in the analysis. The median age of patients was 54 years, with a female preponderance. Eighty-two percent of the patients had chronic headache on presentation. Middle cerebral artery aneurysms (32.2%) and posterior-inferior-cerebellar-artery aneurysms (46.1%) were most common in the anterior and posterior circulation, respectively. The perioperative complication rate was 17.3%. The overall surgical morbidity and mortality were 2.1% and 1.5%, respectively. With median follow-up of 11.3 months, 82% of patients were almost asymptomatic with a complete occlusion rate of 94%. The proportion of UIAs being coiled has significantly increased in the last decade, with a concomitant increase in the risk of poor clinical outcome after surgery.
  
  
  CONCLUSIONS
  Surgical clipping is effective and can provide a good long-term outcome. The most commendable consequence that it provides is a better long-term occlusion rate. The experience of the individual surgeon is important for a superior and enduring overall outcome. An increase in the rate of coiling in recent years has affected the outcome rate after surgery that calls for further evaluation.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Centre, Shreveport, Louisiana, USA. Electronic address: ananda@lsuhsc.edu.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Centre, Shreveport, Louisiana, USA.
authors.forename: Devi Prasad
authors.initials: DP
authors.lastname: Patra
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Centre, Shreveport, Louisiana, USA.
authors.forename: Shyamal C
authors.initials: SC
authors.lastname: Bir
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Centre, Shreveport, Louisiana, USA.
authors.forename: Tanmoy K
authors.initials: TK
authors.lastname: Maiti
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Centre, Shreveport, Louisiana, USA.
authors.forename: Piyush
authors.initials: P
authors.lastname: Kalakoti
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Centre, Shreveport, Louisiana, USA.
authors.forename: Papireddy
authors.initials: P
authors.lastname: Bollam
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Intracranial aneurysm; Microsurgical clipping; Outcome; Single surgeon; Surgery; Unruptured