Outcome of microsurgical clipping for multiple vs single intracranial aneurysms: A single institutional retrospective comparative cohort study

Abstract Objective To evaluate the results of microsurgical clipping for single (SIA) and multiple (MIA) intracranial aneurysms and compare the outcomes. Methods All the patients with intracranial aneurysms(IA) operated at our Institute during 3 years period (June 2013 to May 2016) were included in this study. Results All 157 patients with 225 IA operated during the study period were included. Forty one of these patients had MIA (109 IA, mean-2.7 + 1.2,Range-2to7) and remaining 116 had SIA. Surgery for all the multiple aneurysms in patients with MIA was performed preferably during same admission. Depending on the location of MIA and condition of brain during surgery (tense/lax), all aneurysms were secured on same day (Single session, single or multiple craniotomies-28 patients) or on different days (multiple sessions-13 patients). Postoperative control angiogram (DSA) before discharge could be done for 216 aneurysms (MIA-105,SIA-111). Successful occlusion of the aneurysm from circulation was noted in 96.2 % (101/105) of MIA and 93.7% (104/111) of SIA. Follow-up of 6 months or more was available for 146 patients. Modified Rankin scale(mRS) 2 was considered as good outcome. Univariate analysis of the entire group revealed no significant difference in clinical outcome between patients with SIA and MIA both at discharge (Good outcome:MIAs-82.9%,SIA- 93.1%;Pvalue-0.068) and at a final follow-up of 6 months or more (Good outcome:MIA-87.2%,SIA-94.4%;P value-0.164). Clipping for MIA was not associated with poor outcome in multivariate analysis. Conclusion Comparable clinical outcomes and high complete aneurysm occlusion rates following microsurgical clipping can be expected in patients with SIA and MIA.