To investigate the techniques and clinical efficacy of microsurgical clipping for elderly patients with ruptured anterior circulation aneurysms.

A retrospective analysis was conducted on the medical records of 80 elderly patients with acute ruptured anterior circulation aneurysms who were treated in the Department of Neurosurgery at Dujiangyan Medical Center from May 2012 to December 2022. The surgical approaches included the supraorbital lateral approach, the pterional approach, or an extended pterional incision. Under the microscope and through the lateral fissure approach, some patients underwent puncture of the lateral ventricle's frontal horn at Pain's point or modified Pain's point, followed by intracerebral hematoma evacuation and aneurysm clipping. The aneurysm clipping status was recorded. Follow up for 6 months after surgery, using the modified Rankin scale (mRS) to evaluate the clinical prognosis of patients.

There were a total of 89 aneurysms in this group of patients, of which 74 patients (87 aneurysms) were completely clipped, with a success rate of 97.75%. Postoperative complications included cerebral edema in 31 cases (38.75%), which improved after dehydration treatment; vasospasm in 38 cases (47.50%), which improved after vasodilatory treatment; and hydrocephalus in 24 cases (30.00%), with 9 cases undergoing ventriculoperitoneal shunting resulting in the disappearance of hydrocephalus, and the remaining 15 cases improved after symptomatic treatment. At the 6-month postoperative follow-up, one patient was lost to follow-up. Among the remaining 79 patients, 10 cases had a poor prognosis (mRS 3-6), and 69 cases had a good prognosis (mRS 0-2), with a good prognosis rate of 87.34%.

The method of microsurgical technique for evacuating intracerebral hematoma and clipping aneurysms is highly safe and effective in elderly patients with acute ruptured anterior circulation aneurysms.