Microsurgical Clipping of Anterior Communicating Artery Aneurysms in Limited-Resource Setting: A 14-Year Single-Center Surgical Experience.

Abstract

Anterior communicating artery (ACoA) aneurysms are the most common intracranial aneurysms and carry a high risk of rupture. This study evaluated clinical, radiological, and intraoperative factors associated with outcomes after microsurgical clipping of ACoA aneurysms. In this retrospective cohort study, patients who underwent microsurgical clipping of ACoA aneurysms at a tertiary referral center between 2010 and 2024 were included. Demographic, clinical, radiological, operative, and outcome data were collected from medical records. Functional outcome at 6 months was assessed using the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS). Favorable outcome was defined as GOS ≥4 and mRS <3. Independent predictors of outcome were identified using Firth's penalized logistic regression. A total of 388 patients were included of whom 354 had ruptured aneurysm. Favorable functional outcome at 6 months was achieved in 86% of patients with ruptured aneurysm according to GOS and 85% according to mRS, with an overall survival rate of 90%. Advanced age and lower admission Glasgow Coma Scale (GCS) score were independently associated with unfavorable functional outcomes and mortality. Hydrocephalus independently predicted mortality, while substance use was associated with unfavorable mRS outcome. Patients with unruptured aneurysm demonstrated excellent outcomes with no mortality. Microsurgical clipping of ACoA aneurysms was associated with favorable functional outcomes and acceptable survival. Advanced age, poor neurological status at admission, and hydrocephalus were significant predictors of adverse outcomes. Early identification of high-risk patients and optimized perioperative management may improve outcomes following clipping of ruptured ACoA aneurysms.