ABSTRACT

Background: The anterior communicating artery (AComA) is the most common site for cerebral aneurysms, with a higher prevalence in men than in women. The age distribution of AComA aneurysms is similar to that of aneurysms in general. Aims: The study aims to evaluate the impact of early clipping compared to late clipping on the enhancement of Karnofsky Performance Score in patients diagnosed with anterior communicating artery aneurysms. This research is conducted due to the lack of literature addressing the optimal timing of the clipping procedure concerning pre-operative Hunt and Hess grades. Materials and methods: This is a prospective clinical study performed in Neurosurgery Teaching Hospital, Baghdad, Iraq, to assess the effect of early clippings versus late clippings in 48 patients with A-com aneurysm on their KPS, between January 2018 to January 2021, followed up for 3 months. All patients were assessed preoperatively according to their age, Hunt and Hess grading score, and The Karnofsky Performance Status (KPS) on presentation. CT scan and CT angiography were used as the gold standard. Patients were admitted to the ICU for monitoring. We approach the aneurysm through pterional craniotomy, clip application, and papaverine is applied to all the exposed and manipulated vessels. Postoperatively, patients are monitored in the ICU according to their GCS, neurological examination, KPS, vital signs, and electrolyte level. All patients were sent for follow-up native brain CT scans. Informed consent was adopted from all patients and the study was approved by the ethical committee. Results: This study was done on 48 patients with A-com aneurysm. 58.3% of them were male with the mean age was (42.38 ± 10.688) years. The mean KPS pre-operatively was (59.4± 10.086), reaching (70.63 ± 9.087) on discharge, and (81.67 ± 8.078) on follow-up. 20 of those patients were Hunt and Hess grade 1, 16 were grade 3. There was a highly significant effect of Hunt and Hess grade and clipping timing on the KPS with a p-value less than 0.001. Conclusion: Patients with good pre-operative grades (H&H grades 1&2) demonstrated higher Karnofsky Performance Status (KPS) scores at discharge and during follow-up compared to those with poor pre-operative grades (H&H grades 3, 4, and 5).