Functional Outcome of Microsurgical Clipping Compared to Endovascular Coiling
- Author:
Premananda Raja Murugesu
;
Ramesh Narenthiranathan
;
Hillol Kanti Pal
- Publication Type:Journal Article
- Keywords:
Subarachnoid haemorrhage, ruptured aneurysm, microsurgical clipping, aneurysmal coiling, WFNS
- From:
The Medical Journal of Malaysia
2012;67(6):585-590
- CountryMalaysia
- Language:English
-
Abstract:
Endovascular coiling has been used increasingly as an
alternative to neurosurgical clipping for treating
subarachnoid hemorrhage secondary to aneurysm rupture.
In a retrospective cohort review on the treatment methods
of aneurysm rupture in Hospital Kuala Lumpur over the
period of five years (2005-2009) a total of 268 patients were treated. These patients were broadly categorized into two groups based on their treatment mode for ruptured
aneurysms. Statistical analysis was determined using Chi-
Square tests to study these associations. In our study,
67.5% of patients presented with Good World Federation of
Neurosurgical Societies (WFNS) grade (WFNS1-2) while
32.5% patients presented with Poor WFNS prior to
intervention. In our outcome, it was noted that 60.4% had
good functional outcome (mRS grade 0-2) as compared to
39.6% patients who had poor mRS(modified rankin scale)
outcome (mRS 3-6). In the good WFNS group, 76% of
patients in clipping group had a good mRS outcome while,
86.5% patients in coiling group had good mRS outcome
(p=0.114). In poor WFNS presentation, it was noted that in
77.3% patients in clipping group, had poor mRS outcome.
Similarly with poor WFNS presentation, 83.3% of patient in
coiling group had poor outcome. (p=1.00). Hence when we
control the WFNS group, there was no significant
association between treatment group (clipping and coiling)
and mRS outcome at 6 months. The outcome of patient is
determined by initial clinical presentation (WFNS grade) and influenced by requirement of Extraventricular drain (EVD) in presence of hydrocephalus, CSF infection and pneumonia. Therefore the decision regarding treatment option needs to be individualized based on the presentation of the patient.
