Current treatment management of aneurysmal subarachnoid hemorrhage with prevailing trends and results in Tanzania: A single center experience at Muhimbili Orthopedic and Neurosurgery Institute (MOI).

Overview

abstract

BACKGROUND: In Africa, no cerebral aneurysm treatment guidelines exist. Epidemiology, management, and outcomes after aSAH remain poorly understood, with many underdiagnosed cases. Muhimbili-Orthopaedic-Institute (MOI) is the only neurosurgical referral center in Tanzania. The aim is to describe the current aSAH-management with regional outcomes and limitations. METHODS: Patients with aSAH confirmed by CT-/MR-angiography between February 2019 and June 2021 were retrospectively studied. The analyzed parameters included demographics, clinical/radiological characteristics, injury characteristics, and the modified Rankin Scale (mRS). RESULTS: In total, 22 patients, with a female: male ratio of 1.4 and a median age of 54 years (IQR 47.2 - 63 years) harboring 24 aneurysms were analyzed. Thirteen (59.1%) patients paid out of pocket. The median distance travelled by patients was 537 kilometers (IQR 34.7 - 635 km). The median time between admission-treatment was 12 days (IQR 3.2 - 39 days). The most common symptoms were headache (N=20/90.9%) and high blood pressure (N=10/45.4%). Nine (40.9%) patients had Fisher-grade 1. Twelve (54.5%) WFNS grade I. The most common aneurysms were MCA (7/29.2%). Fourteen (63.6%) patients underwent clipping; of those, only 4 (28.6%) were operated within 72 hours. Mortality was 62.5% in the non-surgical group. Among clipped patients, 78.6% showed favorable outcomes with no mortality. Notably, endovascular treatment is currently not available in Tanzania. CONCLUSIONS: To our best knowledge, this is the first study highlighting the current aSAH management in Tanzania with its assets and shortcomings. Our data show pertinent differences between international treatment guidelines with the resultant outcomes, such as high preoperative mortality due to delayed/postponed treatment. Regional difficult circumstances notwithstanding, our long-term goal is to significantly improve the overall management of aSAH in Tanzania.