Almas Ashraf1*, Zaheer-ud-Din Babar2, Ayesha Jamal3, Hajra Nadir1 and Aisha Ahmed Khan1
1Shifa International Hospital, Pakistan
2Neurosurgeron, Swat Medicial Complex, Swat, Pakistan
3Shifa International Hospital, Clinical Course of Cerebral Aneurysm in Pakistan, Pakistan
*Corresponding Author: Almas Ashraf, Shifa International Hospital, Pakistan.
Received: November 27, 2020; Published: December 22, 2020
Objective: To report the clinical outcome achieved through surgical clipping of ruptured cerebral aneurysms over 7 and half years period in tertiary care hospital of Pakistan.
Material and Methods: A retrospective study of Pakistani patients with ruptured intracranial aneurysms that were operated for clipping. The demographic details, characteristics of ruptured aneurysm, imaging of aneurysm, clinical course, progress and outcome were recorded. Fisher grading and Hunt and Hess criteria were used. Glasgow outcome scale (GOS) was used for final result. Data was recorded and analyze through SPSS version 21.
Results: 86 patients were recruited in 7 and a half year period. Mean age was 50 (SD, 14) years. There were 48 females and 38 males. There was no significant difference in the size of the ruptured aneurysms among both sexes. Two most common sites of rupture were the anterior communicating artery and middle cerebral artery. 11.6% patients had more than one aneurysm. The median door-to-treatment time with IQR was 48 hours. The majority of the patients presented with Grade II and III of Hunt and Hess criteria, while the Fischer grading was severe of Grade III and IV for most of them. The average follow-up was about 3 weeks, 39 out of 86 patients had low disability. Patients above the age of 40 had worse outcome. The mortality rate of the cross-sectional was 14% (12/86). There was no statistical significance seen in patients with GOS and H&H criteria, or GOS and Fischer grading. Post- operatively, 13 patients had hydrocephalus (13 patients), and among which 10 underwent VP shunt.
Discussion: A very low occurrence rate of aneurysm has been seen, which involve many factor, such as eligibility for surgery, financial hurdles, lack of awareness, lack of facilities, among others. The most common location for subarachnoid cerebral aneurysm in Pakistan is anterior communicating artery and second to it is middle cerebral artery. No statistical significance has been seen between Hunt and Hess grading system and outcome scale in this study, while some degree of association has been proven in other studies. Clinical outcomes have been better overall due to early intervention, if to observe factors, age and aneurysm size plays an important role with poorer results with age more than fifty as seen through Glasgow outcome scale. Other factors that matter are slow prognosis, severe clinical symptoms at time of admission and higher frequency of comorbidity. The clinical outlook shows that the most common complication of the clipping was hydrocephalus and wound infection in Pakistani population. Patients were not followed for long term outcome, hence it is a limitation of this study.
Conclusion: Despite the improvements in past two decades, there is a lack of infrastructure and awareness regarding cerebral aneurysm treatment and management in Pakistan. Moreover, alternative methods such as coiling is still not available in the majority of hospitals in Pakistan.
Keywords: Cerebral Aneurysm; Outcome; Subarachnoid Hemorrhage; Ruptured Intracranial; Aneurysm; Clipping
Citation: Almas Ashraf., et al. “Clinical Course of Ruptured Cerebral Aneurysm at Tertiary Care Hospital in Pakistan". Acta Scientific Neurology 4.1 (2021): 22-28.
Copyright: © 2021 Almas Ashraf., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.