Microsurgical clipping of anterior circle of willis aneurysms: a retrospective study

Objective: The surgical outcomes of anterior circle of Willis aneurysms were evaluated. Material and Methods: 38 patients operated and followed up for aneurysms between March 2015 and December 2016. There were 15 female and 23 male patients with a mean age of 47 years (17-78). 35 of the patients were diagnosed with subarachnoid hemorrhage (SAH). Of these patients, 54.2% (n=19) were operated within the first 24 hours. All patients were operated by the same surgeon with sylvian dissection. All clinical data in the hospital charts and outpatient records and radiological investigations of the archive were evaluated retrospectively. Results: The most common aneurysm was seen on anterior communicating artery (44.8%). After that, aneurysms on the middle cerebral artery (31.6%), posterior communicating artery (13.2%), internal cerebral artery bifurcation (7.8%) and distal anterior cerebral artery were seen, respectively. There was a significant difference between the location of the aneurysm and the mean age (p=0.009). All patients were followed in the intensive care unit after operation. Vasospasm was observed in 26.3% of patients after surgery. Patients with high SAH grade had significantly more frequently vasospasm (p=0.03). Neurological examinations were normal in 17 patients with SAH and 3 patients without SAH during discharge. 4 patients were discharged with minimal neurological deficit and 2 patients with severe deficit. 8 patients with World Federation of Neurosurgical Societies (WFNS) grade 4-5, 2 patients with grade 3 and 2 patients with grade 1-2 were lost. Postoperative Glasgow Coma Scale and SAH WFNS grades were found to be determinant for dying. Conclusion: Despite the development of endovascular techniques in the treatment of aneurysm, microsurgical clipping remains the first choice method to treat anterior system aneurysms. Closure of an aneurysm is the priority in the treatment. It is well known that early surgery reduces mortality and morbidity.