Microsurgical Clipping of Ruptured Cerebral Aneurysms in a Regional Hospital: A 7-Year Single-Surgeon Experience

Abstract Microsurgical clipping remains a vital treatment for ruptured cerebral aneurysms, particularly in regional hospitals where emergent endovascular access may be limited. Timely surgery by experienced neurosurgeons can yield favorable outcomes even outside academic centers. The aim of the study is to evaluate clinical outcomes of microsurgical clipping for ruptured cerebral aneurysms performed by a single neurosurgeon in a regional hospital over a seven-year period, with subgroup analysis by WFNS grade. A retrospective cohort study was conducted on 189 patients with radiologically confirmed ruptured cerebral aneurysms who underwent microsurgical clipping at our center between July 2018 and June 2025. Data on demographics, aneurysm characteristics, clinical grade, surgical timing, and outcomes were analyzed. Subgroup analyses included WFNS grade (good-grade I–III vs. poor-grade IV–V), timing of surgery, and operative phase. Favorable outcome was defined as a modified Rankin Scale (mRS) score of 0 to 2 at 6 months. Good-grade WFNS patients comprised 59.3% of the cohort and achieved excellent outcomes, with 85.1% attaining mRS 0 to 2 at 6 months. Ultra-early surgery (<24 hours) was performed in 58.2% of cases. Overall mortality was 6.3%. At 6 months, 74.6% of all patients had favorable outcomes. Poor initial WFNS grade (OR 0.33, p = 0.011) and vasospasm (OR 0.15, p < 0.001) were independently associated with unfavorable outcomes. Microsurgical clipping remains a safe and durable option for ruptured cerebral aneurysms in regional practice. With consistent surgical experience and timely intervention, outcomes comparable to those of academic centers can be achieved.