Surgical management of Aneurysmal Subarachnoid Haemorrhage in a resource-constrained region: A Nigerian regional experience

Omotayo Abimbola Ojo; Olufemi Babatola Bankole; Chiazor Udochukwu Onyia; Opeyemi Awofeso; Yusuf Dawang

doi:10.1016/j.bas.2023.101778

Surgical management of Aneurysmal Subarachnoid Haemorrhage in a resource-constrained region: A Nigerian regional experience

Brain Spine. 2023 Jul 17:3:101778. doi: 10.1016/j.bas.2023.101778. eCollection 2023.

Authors

Omotayo Abimbola Ojo¹, Olufemi Babatola Bankole¹, Chiazor Udochukwu Onyia², Opeyemi Awofeso³, Yusuf Dawang⁴

Affiliations

¹ Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria.
² Department of Surgery, Lagoon Hospital, 17B Bourdillon Road, Ikoyi, Lagos, Nigeria.
³ Lagos University Teaching Hospital, Lagos, Nigeria.
⁴ Department of Surgery, University of Abuja Teaching Hospital, Abuja, FCT, Nigeria.

Abstract

Background: Aneurysmal Subarachnoid Haemorrhage (aSAH) is a vascular injury with significantly high mortality, especially when poorly managed. This study seeks to outline the experiences in setting up a neurovascular service in Lagos, Nigeria.

Methods: A series of 45 patients were operated after aSAH over a period of 10 years. Patients consecutively were recruited following computed tomography angiography (CTA) diagnosis of aSAH. Clinical data were recorded on a predesigned form after obtaining informed consent; aSAH was classified using the WFNS classification, intraoperative findings were documented. Challenges in the management were analysed in a post-operative root cause analysis (RCA) review. Outcomes and factors responsible for the observed outcomes and actions taken were recorded.

Results: Forty-five patients were operated after aSAH was confirmed; there were 29 females and 16 males. (M:F 1:1.8), the age ranged from 14 to 76 years (mean 49.1±13.58). All the aneurysms were on the anterior circle of Willis, mainly on Anterior Communicating Artery aneurysm (18/48).Thirty-eight patients (84.4%) survived and were discharged within an average of 10 days after surgery. Lower GCS at presentation was associated with poor prognosis (p = 0.026); however, data analysis demonstrated that other factors (financial issues, lack of appropriate instrumentation and equipment, experience of the surgeon) played a significant role in determining the outcome.

Conclusions: Aneurysmal Subarachnoid Haemorrhage (aSAH) is a challenging pathology and its management may be further burdened in resource constrained countries, as shown by the data analysed in this study from Lagos, Nigeria. Specialized and well-funded Neurovascular centres are needed to overcome the challenges faced and to improve care for aSAH patients in Nigeria.

Keywords: Aneurysmal subarachnoid haemorrhage; Clipping; Low income country; Nigeria.