Dome protection prior to microsurgical clipping versus direct microsurgical clipping of ruptured intracranial aneurysms: A multicenter analysis.
Publication/Presentation Date
5-6-2026
Abstract
BACKGROUND AND OBJECTIVES: Dome protection involves partial coil embolization of an intracranial aneurysm prior to definitive treatment. The present study compared outcomes of dome protection followed by microsurgical clipping with direct microsurgical clipping of ruptured intracranial aneurysms.
METHODS: This multicenter study included patients who underwent either dome protection followed by microsurgical clipping or direct microsurgical clipping of a ruptured intracranial aneurysm at three participating centers across North America. Propensity score weighting was carried out using the inverse probability of treatment weights (IPTW) to adjust for confounders. Outcomes of interest were intra-operative rupture (IOR), vasospasm, non home discharge (NHD), in-hospital mortality and length of stay (LOS).
RESULTS: Of 208 patients, 15.72% (N = 33) underwent dome protection followed by microsurgical clipping and 84.18% (N = 175) underwent direct microsurgical clipping. After IPTW adjustment, dome protection was not associated with decreased risk for IOR (OR: 0.59, 95% CI: 0.14--2.52, P = 0.481), vasospasm (OR: 0.79, 95% CI: 0.28--2.25, P = 0.654), NHD (OR: 0.52, 95% CI: 0.19--1.39, P = 0.193) or in-hospital mortality (OR: 0.2, 95% CI: 0.02--1.75, P = 0.148) compared to direct microsurgical clipping. Patients who underwent dome protection experienced significantly longer LOS compared to direct microsurgical clipping, with an average of 4.59 days, 95% CI: 1.15--8.03, P < 0.01).
CONCLUSION: Dome protection prior to microsurgical clipping is associated with comparable rates of IOR, vasospasm, in hospital mortality and NHD compared to direct microsurgical clipping of ruptured aneurysms. Patients who underwent dome protection experienced longer LOS compared to those who underwent direct microsurgical clipping. Future studies could evaluate the cost-effectiveness and clinical utility of dome protection in the management of ruptured intracranial aneurysms.
Volume
150
First Page
112070
Last Page
112070
ISSN
1532-2653
Published In/Presented At
Roy, J. M., Musmar, B., Patel, P., Kaul, A., Pontarelli, M. K., El-Hajj, V. G., Jaffer, A., Chen, A. Y., Shteingart, J., Busarajan, S., Rizzuto, M., Hoglund, Z., Scott, K. W., Charcos, I., Burkhardt, J. K., Srinivasan, V., Tonetti, D., Tjoumakaris, S. I., Gooch, M. R., Alshahrani, R., … Jabbour, P. M. (2026). Dome protection prior to microsurgical clipping versus direct microsurgical clipping of ruptured intracranial aneurysms: A multicenter analysis. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 150, 112070. Advance online publication. https://doi.org/10.1016/j.jocn.2026.112070
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42096731
Department(s)
Administration and Leadership
Document Type
Article