A case that encapsulates the challenges of being a neurosurgeon in war-torn countries: Perspectives from Iraq

Abstract

Background: The provision of healthcare services in Iraq has been negatively affected by a lack of resources, strained healthcare infrastructure, and low patient socioeconomic status. This paper describes a case of multiple intracranial aneurysms (MIAs) that highlight the challenges of practicing vascular neurosurgery in Iraq.

Case description: A 57-year-old female presented with sudden-onset severe headache, photophobia, and drowsiness and was diagnosed with subarachnoid hemorrhage in the basal cistern. Despite international guidelines recommending urgent treatment for suspected ruptured intracranial aneurysms, the patient's healthcare team in Babylon advised against a CT angiogram (CTA). The patient's family took responsibility for transferring her to a private facility for a CTA, which showed four aneurysms. Due to financial constraints, the family opted for open surgery, during which a ruptured aneurysm was found and successfully managed. The remaining two aneurysms were monitored with serial follow-up imaging.

Conclusion: The case highlights the challenges of practicing vascular neurosurgery in Iraq and the impact of financial constraints on the management of MIA. It emphasizes the need for increased resources and expertise in the country's healthcare system to provide optimal care for patients with life-threatening conditions.

Keywords: Intracranial aneurysm; Iraq; Low- and middle-income countries; Vascular neurosurgery.

Figure 1:

(a) A non-contrast computed tomography scan showing scan axial section showed subarachnoid hemorrhage in the basal cistern with no predominant clue for the location of the ruptured aneurysm. (b) A mapping illustration showing the distance between Babylon and Baghdad with the time needed to reach the destination in a personal vehicle.

Figure 2:

3D angiogram showing (a) right posterior communicating artery and right superior hypophyseal artery aneurysms. (b) Left posterior communicating artery aneurysm. (c) Right intraorbital ophthalmic artery aneurysm.