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. 2022 Sep 12;63(4):312-320.
doi: 10.60787/NMJ-63-4-75. eCollection 2022 Jul-Aug.

Outcome of Cerebral Aneurysm Clipping in Nigeria: A Single-Centre Experience

Jeuel O Idowu  1 , Olufemi Idowu  2   3 , Stephen O Oyeleke  3
Affiliations

Outcome of Cerebral Aneurysm Clipping in Nigeria: A Single-Centre Experience

Jeuel O Idowu et al. Niger Med J. .

Abstract

Background: Ruptured cerebral artery aneurysms (RCAA) are devastating diseases with high morbidity and mortality rates if not promptly managed. In Nigeria, access to timely neurosurgical services remains a challenge and aneurysm coiling is still not possible in virtually all centres in Nigeria. The aim of this study is to report on our 9 years' experience with clipping of cerebral aneurysm and on the attendant clinical outcomes.

Methodology: A retrospective analysis of all consecutive operated RCAA between March 2012 and June 2021 was conducted. Patients' demographic parameters, World Federation of Neurosurgical Societies (WFNS) grade, Hunt and Hess (HH) grade, aneurysm location, timing of surgery and outcome were analysed. Outcome was measured using Glasgow Outcome Scale (GOS) score.

Results: A total 29 were included in the study. The most common age group affected was between 50-59 years. RCAA were mainly in the region of the middle cerebral artery and posterior communicating artery (PComA) territories. All the patients presented after 24 hours of the ictus. Two (6.9%) patients had multiple aneurysms. Early clipping (<72hours after presentation) was possible in 8 (27.6%) patients. At least one episode of a rebleed occurred in 19 (65.5%) patients prior to surgery. Mortality rate was 17.2%. None of the patients with PComA aneurysm died. The patients' pre-operative WFNS and HH grades were significantly associated with GOS.

Conclusion: Modifiable factors like under diagnoses, delayed referral, cultural belief and financial challenges may account for the low number of patients presenting for neurosurgical care. The possibility of a sizeable number of patients dying due to these factors is a strong possibility for the low number of patients presenting for neurosurgical care.

Keywords: Aneurysm; Anterior Communicating Artery; Clipping; Middle Cerebral Artery; Posterior Communicating Artery.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Age distribution (in years) of male and female patients with ruptured aneurysm
Figure 2:
Figure 2:
Aneurysm location (AComA- Anterior communicating artery, DACA- Distal anterior cerebral artery, MCA- Middle cerebral artery, PComA- Posterior communicating artery) based on gender
Figure 3a, b:
Figure 3a, b:
Intra operative (a) and post-operative (b) images of clipped middle cerebral artery aneurysm
See this image and copyright information in PMC

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