Vascular Neurosurgery Practice In Resource Limited Settings, Our Experience From Kano Nigeria

Abstract

Objective
We present our one-year experience at establishing a vascular neurosurgery practice from Kano Nigeria with the aim of evaluating challenges and outcomes

Methods
Patients with intracranial aneurysms and arteriovenous malformations presenting to Aminu Kano Teaching Hospital as well as private facilities within Kano Metropolis from September 2021 to September 2022 were reviewed.

Results
A total of 11 patients with intracranial aneurysms and 4 patients with intracranial AVMs were seen constituting 73.3% and 26.7%.
Of the patients with intracranial aneurysms, 45% had MCA Aneurysms, 27% had ICA aneurysms, while ACOM and pericallosal aneurysms constitute 9% each; Majority (81%) of the aneurysms were ruptured at presentation with WFNS grade III in 54% and grade I in 18% and grade V in 18%. Only 27% had surgical clipping while 1 patient had endovascular coiling abroad. The rest couldn’t afford any intervention while one patient died while awaiting intervention.
Of the patients with AVMs, the locations varied with one each in the parietal, parasagittal, Occipital and posterior fossa regions and thus varying presentations ranging from seizures to drop attacks. Suplemented Spetzler Martin grading was 6 in 75%. Two of the patients (50%) had surgical resection of the AVM, one has been referred for endovascular therapy while one opted for treatment abroad.

Conclusion
Intracranial vascular lesions are very common in our locality and are being exposed by availability of advanced diagnostic facilities. However, majority of the patients cannot afford any intervention as only 13.3% of our patients could afford treatment.