Surgery for Ruptured Aneurysms: Analysis based on 40 cases

Abstract

Intracranial aneurysms are commonest cause of spontaneous subarachnoid haemorrhage. The aim of this retrospective study was to see distribution of this disease over circle of will is and analyse outcome of surgical treatment in our set-up. Forty patients with subarachnoid haemorrhage due to ruptured intra-cranial aneurysms were operated upon from October 99 to September 2002. Age ranged from 30-65 years with mean of 40 years. There were 24 females and 16 males (sex ratio 1.5:1). Those patients who died while waiting for cerebral angiogram and angio negative patients were excluded from this study. Clinical grading was done according to Hunt & Hess Scale (table 1) and only those patients proceeded to cerebral angiogram who improved to at least grade 3 on this scale. We found that 80% aneurysms in our referrals were A CoA (Anterior communicating artery), 15% MCA (Middle cerebral artery) and 5% P Com (posterior communicating artery). There was no posterior circulation aneurysm among 40 cases. Only one patient had multiple aneurysms. Timing of operation ranged from 3-18 days
with mean of 10 days. We conclude that A CoA is the commonest aneurysm (80%), followed by MCA and P-Corn. This is in contrast to most of western literature where A CoA Aneurysm is found in 35-40% cases of SAH. Rarity of Posterior circulation aneurysm (none in our study) suggests different distribution of disease in this part of the world. Moreover, less multiplicity (2.5%) could suggest low incidence of disease in Pakistan. It is possible to clip aneurysms with only 5% mortality at our centre, which compares favourably with western series.