| Objective: Today, neurosurgical clipping and endovascular coiling are two main surgical methods in treating intracranial aneurysms, and comparison of the two methods are still controversial .The clinical data of the patients with ruptured intracranial aneurysms suitable for either treatment were retrospectively reviewed and analyzed to compare the complications, prognosis, hospital day and follow-up after treatment, then a preliminary assessment of the safety and efficacy of two methods was gained.Materials and methods: Patients with ruptured intracranial aneurysms admitted into Department of Neurosurgery of Shandong Provincial Hospital Affiliated to Shandong University between June 2003 and March 2009 were reviewed. The following excluded: false aneurysms; posterior circulation aneurysms; middle cerebral artery bifurcation aneurysm; the body cound not tolerate surgery; Hunt-Hess grade V; aneurysms which located at petrous segment or the cavernous sinus segment of internal carotid artery and cases who gave up. Finally 132 cases which were suitable for either treatment were selected. According to the actual situation, they chose one method and divided into two groups. In which 79 cases of neurosurgical clipping, the average age was 50.0 years old. There were total 83 aneurysms in this group. A total of 79 cases of patients with 83 aneurysms (75 cases with single aneurysm, 4 cases with multiple aneurysms).The location of the aneurysms: 31 aneurysms at the posterior communicating artery, 8 aneurysms at carotid artery, 37 aneurysms at anterior communicating artery, 3 aneurysms at anterior cerebral artery, 4 aneurysms at middle cerebral artery. Hunt and Hess grade: 39 cases of gradeâ… , 23 cases of gradeâ…¡, 14 cases of gradeâ…¢, 3 cases of gradeâ…£; There were 53 cases with 55 aneurysms (51 cases with single aneurysm, 2 cases with multiple aneurysms) in the group of endovascular treatment, the average age 47.9 years old. The location of the aneurysms: 21 aneurysms at the posterior communicating artery, 6 aneurysms at carotid artery, 25 aneurysms at anterior communicating artery, 1 aneurysms at anterior cerebral artery, 2 aneurysms at middle cerebral artery. Hunt and Hess grade: 19 cases of gradeâ… , 21 cases of gradeâ…¡, 10 cases of gradeâ…¢, 3 cases of gradeâ…£. The complications, prognosis, hospital day and follow-up of two groups were compared. Then statistical analysis was performed using X~2 and t test.Results: There were 18 patients who developed complications in the group of neurosurgical clipping, and the incidence rate was 22.8%. 5 cases developed complications in the group of endovascular treatment, and the incidence rate was 9.4% . The difference between two groups were obvious(x~2=3.930, P=0.047); 9 cases had poor prognosis at discharge (GOS 1-3) in the group of neurosurgical clipping, and the incidence rate was 11.4% with an average GOS 4.77. while 3 cases had poor prognosis at discharge in the group of endovascular treatment, and the incidence rate was 5.7% with an average GOS 4.57. The difference between two groups were not obvious(x~2=0.663, P=0.416); One case in group of neurosurgical clipping died, while no one died in the other group. The mortalities were respectively 1.3% and 0, and the difference between two groups were not obvious(x~2=0.000, P=1.000); The average hospital day were respectively 20.55 and 14.28, and the difference between two groups were obvious(x~2=3.698, P=0.000); There were respectively 56 and 42 cases followed-up in group of neurosurgical clipping and endovascular treatment, only one case with endovascular treatment relapsed. The rates of recurrence were respectively 0 and 2.4%, and the the difference between two groups were not obvious(x~2=0.021, P=0.885).Conclusion: The rates of complications in the group of endovascular treatment were obviously lower than the group of neurosurgical clipping. The rates of poor prognosis and the mortalities in the group of endovascular treatment were slightly lower than the group of neurosurgical clipping, and there were no significances in statistics. The hospital days of endovascular treatment were obviously shorter. The rate of recurrence in two groups was both low, and there were no significances in statistics. This study shows that the safety and efficacy of the endovascular treatment is superior to neurosurgical clipping, but still requires long-term follow-up.
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