Clipping of Unruptured Intracranial Aneurysm via Various Keyhole Mini-craniotomy Procedures: Substantial Curability and Psychological Comfort in 350 Cases over 20 Years

The long-term efficacy of clipping unruptured intracranial aneurysms via various keyhole minicraniotomy procedures was evaluated. A retrospective review was conducted on 350 unruptured intracranial aneurysms (6.1 ± 1.9 mm) in 330 patients (218 women and 112 men, mean age 62 ± 10 years) located in the anterior circulation and clipped via various keyhole mini-craniotomy procedures between July 2005 and December 2023. modified Rankin Scale and Mini-Mental State Examination were evaluated. Anxiety and depression were assessed using the Beck Depression Inventory and the Hamilton Rating Scale for Depression. The state of clipping was assessed by computed tomography angiography at 1 year and at intervals of a few years. The mean size of the craniotomy was 26.5 ± 3.4 mm and the complete neck clipping rate was 96.9%. The mean postoperative hospitalization was 2.7 ± 3.6 days. Two patients (0.6%) experienced symptomatic lacunar infarctions. Surgical morbidity (modified Rankin Scale >2 or Mini-Mental State Examination <24) at 3 months, 1 year, and at the last examination (mean 6.6 ± 4.4 years) was 0.9%, 1.5%, and 1.8%, respectively. Neither neurological state nor cognitive function changed significantly during the follow-up period. Anxiety and depression states improved significantly at 3 months after surgery. During radiological follow up (mean 7.1 ± 4.6 years, range 1-19 years), the rates of regrowth of aneurysm remnant, recurrence, retreatment, and rupture were 18.1% (1.6%/year), 0.9% (0.1%/year), 0.9% (0.1%/year), and 0.3% (0.04%/year), respectively. Our study confirmed that keyhole clipping of unruptured intracranial aneurysm had low morbidity, early recovery in anxiety and depression, and very low aneurysm recurrence and retreatment rates, indicating that this modality is substantially curative.