Clinical and surgical outcomes of bilateral intracranial aneurysms clipped through a single craniotomy: a retrospective comparative cohort study.

OBJECTIVE

The objective was to compare the clinical and surgical outcomes of patients with bilateral intracranial aneurysms treated via a single craniotomy against those treated with bilateral craniotomies.

METHODS

A retrospective analysis was conducted on 50 patients who underwent microsurgical clipping of bilateral aneurysms-specifically involving the middle cerebral artery (MCA) or internal carotid artery (ICA)-between 2008 and 2019. Clinical, demographic, and morphological variables were recorded. Clinical outcomes were compared between patients who were treated through a single craniotomy (n = 32) against those who underwent bilateral craniotomies (n = 18). Aneurysm occlusion and rebleeding rates were compared between aneurysms on the basis of whether clipping was performed via an ipsilateral or contralateral approach.

RESULTS

Thirty-seven patients (74%) presented with subarachnoid hemorrhage. A total of 125 aneurysms were included: 84 (67.2%) were clipped ipsilaterally and 41 (32.8%) contralaterally. No significant differences were observed in clinical presentation, duration of surgery, complication rates, length of hospitalization, mortality, or functional outcomes at 6-month follow-up between the two groups. The median (IQR) postoperative hospital stay was 8 (13) days in the single craniotomy group and 14 (12) days in the bilateral craniotomy group, though this difference was not statistically significant (p = 0.054). The intercarotid distance was significantly shorter in the single craniotomy group (p = 0.007). Operative bleeding was greater in the single craniotomy group (p < 0.001). Aneurysms clipped ipsilaterally exhibited significantly greater dome height (p = 0.013) and were more complex (p = 0.003). No significant differences were found in aneurysm occlusion, rebleeding, or reintervention rates between groups.

CONCLUSIONS

In patients with bilateral ICA or MCA aneurysms, clipping via a single craniotomy provides clinical outcomes comparable to bilateral craniotomies. Contralateral clipping does not adversely affect occlusion or complication rates, supporting the safety and feasibility of a unilateral surgical approach for safe microsurgical clipping in selected cases of bilateral aneurysms.