Hemodialysis elevates postoperative seizure risk without worsening overall outcomes after surgical clipping of unruptured intracranial aneurysms

Patients with end-stage renal disease on long-term hemodialysis (HD) are at increased surgical risks due to chronic uremia, vascular fragility, and associated comorbidities. Limited data exist regarding outcomes of surgical clipping of unruptured intracranial aneurysms in patients on HD. We retrospectively reviewed the data of 425 patients who underwent surgical clipping of unruptured intracranial aneurysms. Among the 425 patients, 15 were on maintenance HD. We performed 1:2 propensity-score matching, adjusting for patient demographics, comorbidities, and aneurysmal characteristics, to yield 30 matched non-HD controls. Clinical data, including postoperative complications and modified Rankin scale (mRS) scores at three months postoperatively, were compared between the two groups. No significant differences were observed between the HD and non-HD groups regarding the incidence rates of postoperative stroke, hemorrhage, or infection. A good functional outcome (mRS score ≤ 3) was achieved in 93.3% and 96.7% of patients in the HD and non-HD groups, respectively (p = 1.000). However, postoperative seizures were significantly more frequent in the HD group than in the non-HD group (53.3% vs. 3.3%, p < 0.001). In the HD group, patients who developed postoperative seizures were significantly less likely to have received prophylactic anti-seizure medication than those who did not develop postoperative seizures (25.0% vs. 85.7%, p < 0.05). Surgical clipping of unruptured intracranial aneurysms in hemodialysis patients appears safe and effective, with outcomes comparable to non-hemodialysis patients despite a higher risk of postoperative seizures. Tailored perioperative seizure prophylaxis is essential in this population.