Clipping Of Ruptured Intracranial Aneurysms In Early Phase:A Clinical Study

Objective: This study was designed to summary the clinical outcome and angiographic results of clipping of intracranial ruptured aneurysms in early subarachnoid hemorrhage phase,and to e Valuate the safety and efficacy of the technique for this kind of aneurysms.Methods: A retrospective study was perfomed for intracranial ruptured aneurysms in early subarachnoid hemorrhage phase between Januray 2012 and December 2013. We reviewed data from 58 consecutive patients with ruptured aneurysms who had clipping performed within 48 hours of onset. Data collected and analyzed included: patient demographics;morphologic features of the aneurysm; treatment results and follow-up results. Clinical outcomes were evaluated by modified Rankin Scale(m RS).Results: In our series, 21 males were incuded with an average years of 60.4 ± 9.1, 37 females were incuded with an average years of 62.9±9.4. The neurological conditions of our series were evaluated by Hunt-Hess, with a result that Hunt-HessⅠin 17 patients, Hunt-HessⅡin 26 patients, Hunt-HessⅢin 8 patients, Hunt-HessⅣin 12 patients and unt-Hess V in 5patients. In our series, there were 56 aneurysms in anterior circulation, 2 neurysms in posterior circulation.According to the size, 23 aneurysms was samller than 5mm, the mean±standard diameter is3.1±1.1 mm, the mean±standard neck size is 3.8±0.9 mm, with a result of complete clipping in 22 patients(95.7%), near clipping in 1 patient(4.3%), and no paitent with partial clipping.25 aneurysms between 5 mm and 15 mm, the mean±standard diameter is 8.6±3.1 mm, the mean±standard neck size is 5.2±3.4 mm, with a result of complete clipping in 23 patients(92%), near clipping in 2 patients(8%), and no paitent with partial clipping. 10 aneurysms larger than 15 mm, the mean±standard diameter is 18.3±4.7 mm, the mean±standard neck size is 8.8±3.6 mm, with a result of complete clipping in 7 patients(70%), near clipping in 2patients(20%), and 1 patient(10%) with partial clipping. The clinical outcome of 58 patients showed that 39 patients(67.2%,m RS 0-2) had a good outcome, 8 patients(13.6%,m RS 3-5)had a poor outcome and died in 11 patients(19.0%,m RS 6). Treated-related complications were founded 17patients(29.3%) with intracranial hematoma, infarction in 4patients(6.9%),hydrocephalus in 4 patients(6.9%), re-rupture in-operation in 3 patients(5.2%)and re-rupture post-operation in 2 patients(3.4%).Conclusions: Our study conforms that clipping is a safe and viable option for treatment of ruptured aneurysms in early subarachnoid hemorrhage phase, especially for those with Hunt-Hess I-II patients. Nevertheless, long-term follow-up remains necessary to determine the durability of these promising results. Aneurysm size is relevant with the clipping result of aneurysm, that is, large-sized aneurysm, medium-sized aneurysm and small-sized aneurysm is relevant with the clipping results of aneurysm.