A Review Of Aneurysmal Clipping At Knh: With Case Illustrations And Literature Review

Abstract

Introduction: Aneurysmal sub-arachnoid hemorrhage pauses a significant burden in neurosurgical morbidity worldwide and in Kenya. Generally, options of management are either surgical clipping or use of endovascular techniques. This article focuses on the surgical management of raptured aneurysms carried out in Kenyatta National Hospital (KNH) over the last 3 years. Objectives: To highlight the common surgically managed intracranial aneurysms at KNH, to review management of ruptured intracranial aneurysms presenting at KNH, and highlight illustrative cases of aneurysmal clipping done in KNH. Methods: Retrospective records review of patients who presented to KNH with aneurysmal subarachnoid hemorrhage, and were subsequently micro-surgically clipped in the last 3 years. Results: From 2020 to date, 13 aneurysms were micro-surgically clipped at KNH; 30.8% in 2020, 46.2% in 2021 and the remainder in 2022. All were anterior circulation berry aneurysms, and delayed clipping was done. Anterior communicating artery aneurysms were the commonest at 30.8%, followed by Posterior communicating and MCA aneurysms at 23.1% each. The least common type was DACA aneurysm at 7.7%. Most of the patients were male, corresponding to 61.5% of those operated. Surgical approaches employed, were tailored to the type and location of the aneurysm as the case illustration show. Most of the patients had acceptable post-operative functional outcomes. Conclusions: Microsurgical clipping is the mainstay surgical management of patients with ruptured aneurysms at KNH. Endovascular techniques are not available and therefore not an option at the institution. Patients generally present late and coupled with financial burden, there is a marked delay in surgical intervention.