Surgical Management of Anterior Circulation Aneurysms: Outcomes from a Single-Centre Cohort Study

Background: Intracranial aneurysms of the anterior circulation constitute the majority of spontaneous non-traumatic subarachnoid hemorrhage (SAH) and are associated with significant morbidity and mortality. Although endovascular techniques have expanded rapidly, microsurgical clipping continues to play a pivotal role, particularly for aneurysms with complex morphology and in resource-limited healthcare settings. Contemporary outcome data from Indian government tertiary care centres remain limited. Objectives: To evaluate the clinical profile, intraoperative events, perioperative complications, and early functional outcomes of patients undergoing microsurgical clipping for anterior circulation aneurysms at a single tertiary care centre. Methods: This prospective observational cohort study was conducted in the Department of Neurosurgery, Sassoon General Hospital, Pune, over a three-year period (January 2020–December 2022). Twenty-five consecutive adult patients with anterior circulation aneurysms who underwent primary microsurgical clipping were included. Both ruptured and unruptured aneurysms were analyzed. Data regarding demographics, clinical presentation, radiological characteristics, intraoperative findings, postoperative complications, and neurological outcomes at discharge were collected. Functional outcome was assessed using the Glasgow Outcome Scale (GOS). Statistical analysis was primarily descriptive, with results expressed as means, proportions, and 95% confidence intervals. Results: The mean age of patients was 48.6 ± 9.3 years, with a slight female predominance (56%). Ruptured aneurysms accounted for 72% of cases. The most common aneurysm location was the anterior communicating artery (40%), followed by the middle cerebral artery (32%) and internal carotid artery (28%). All patients underwent clipping via a pterional approach. Intraoperative rupture occurred in one patient (4%) and was successfully managed without permanent neurological deficit. No intraoperative or 30-day mortality was recorded. Postoperative complications were minimal (8%) and transient. Favorable functional outcomes (GOS 4–5) were achieved in 96% of patients, with 84% demonstrating complete recovery (GOS 5) at discharge. Conclusion: Microsurgical clipping of anterior circulation aneurysms can be performed with excellent safety and efficacy in a well-equipped tertiary care government hospital. The low complication rate, absence of mortality, and high proportion of favorable neurological outcomes reaffirm the continued relevance of surgical clipping as a definitive and durable treatment modality, particularly in resource-constrained settings.