Ruptured Intracranial Aneurysms Operated in Antananarivo: Epidemiology and Prognosis Factors

Abstract

Introduction: Ruptured intracranial aneurysm is a diagnostic and therapeutic emergency. Surgery remains the only therapeutic option available in Madagascar.Method: This is a retrospective, descriptive and analytical, multicenter study over a period of 4 years (January 2017 to December 2020) in the Neurosurgery Department of the public hospital in Antananarivo. The objective of this study is to determine the epidemic-clinical profile and prognostic factor of ruptured and operated intracranial aneurysm.The regression coefficient or estimation that quantifies the association between the variables was performed, considering a statistical significance threshold of p<0.05Results: 55 patients were included, 19 men and 36 women, aged 30 to 72 years with a mean age of 50 years. The most reported medical history was hypertension (60%), alcoholism (42%), and smoking (33%). The majority of patients (71%) consulted within the first 3 days after the onset of symptoms, for sudden headaches (62%) or consciousness disorders (36%). The clinical examination revealed a Glasgow score of 15 (42%) and 14 (18%). The Hunt and Hess score and the WFNS score were 2 in 44% and 40% of cases respectively. On the brain scan, the Fischer score was 3 in 40% of cases and the aneurysm was in the anterior communicating artery in 45% of cases. None of the patients could benefit from cerebral arteriography due to the unavailability of the latter in the country. Surgery was performed after the 10th day in 34% of cases, and the outcome was favorable in 65% of cases. A mortality rate of 22% was observed. Among the prognostic factors associated with death; we note: Glasgow score less than or equal to 7 (p=0.0001) and Fischer score greater than or equal to 3 (p=0.009). Conclusion:The epidemiological profile of ruptured intracranial aneurysms in our context is superimposable to that of the literature. Access to modern neuroradiology remains limited and underestimates their incidence. Surgical securing of the aneurysm offers a better result despite the rather high death rate.