Characteristics and Outcomes of Patients with Anterior Circulation Intracranial Aneurysm Managed with Clipping in Hospital Sungai Buloh|
Ailani, Ab. Ghani; Saiful Azli, Mat Nayan; Kandasamy, Regunath; Azmin Kass, Rosman & Abdul Rahman Izani, Ghani
Introduction: The annual incidence of intracranial aneurysm in Malaysia is estimated
to be 1.1–1.7 per 100,000 population based on a study done conducted in 1988. Since then, little
epidemiological research has been conducted in Malaysia, and the real incidence is therefore
probably unreported despite advancements in the diagnosis and treatment of this disorder.
Intracranial aneurysm may be treated by microsurgical clipping or embolisation depending on its
location and the surgeon’s preference. This study aims to report the characteristics and outcomes
of patients with a clipped anterior circulation aneurysm in Hospital Sungai Buloh.
Methods: We retrospectively collected the data of patients with anterior circulation
aneurysms who underwent clipping from 1 January 2013 until 30 June 2014 in Hospital Sungai
Results: The mean age of the patients was 48.9 years old, and 56.7% of the study
population were male and 63.3% were Malay. There were almost equal numbers of patients with
(46.7%) and without (53.3%) co-morbidities such as hypertension and ischaemic heart disease.
Half of the study population fell under Fisher grade 3 (50.0%), whereas 46.7% were Fisher grade
4. With respect to the Navarro score, 20% of patients scored 10, 16.7% scored 5 or 7, 13.3% scored
11, 10% scored 9, 6.7% scored 1 and 3.3% scored 2, 3 or 8. Most of the patients fell under grade
I (33.3%) of the World Federation of Neurological Societies grading (WFNS), and the fewest
number of patients were grade III (3.3%). Most (56.7%) patients had an intracranial aneurysm
located at the anterior communicating artery (ACOM), followed by the anterior cerebral artery
(ACA) and the middle cerebral artery (MCA) (16.7% each), the posterior communicating artery
(PCOM) (6.7%) and, finally, the internal carotid artery (ICA) (3.3%). Neurological outcomes at
three and six months were assessed using the Modified Rankin Scale (mRS). At three months
follow-up, the majority of the participants (33.3%) scored 0 or 6, whereas at six months follow-up,
the majority scored 0 (43.3%).
Conclusion: The main characteristics of patients in Hospital Sungai Buloh were that they
were in their 40s and mostly Malays without any known comorbidities. Although the majority
of patients had high Fisher grades, their outcomes post intervention were promising. However, as data collected from Hospital Sungai Buloh may not be representative of the whole country, a
larger-scale data collection is necessary to create our own database and to identify the risks
factors that are exclusive to our country, if present.
intracranial aneurysm; subarachnoid hemorrhage; characteristic; outcome; Malaysia