P120 The burden of the management of cerebral aneurysms in Africa: a scoping review

Introduction In Africa, the epidemiology, management, and prognosis of cerebral aneurysms remain poorly understood. Cerebral aneurysms are still highly underdiagnosed and inadequately treated in Africa due to a lack of vascular neurosurgeons and infrastructure. In this review we mapped the burden and management of intracerebral aneurysm in Africa. Methods A full systematic search on articles published in Africa on brain aneurysms was performed in PubMed, African Journals Online, Google Scholar, WHO Global Health Library and LILACS with no language restrictions. The search results were merged, uploaded into Rayyan software, (FDT, USK, IN, NDAB) independently based on the pre-defined inclusion and exclusion criteria. The full text of the remaining articles were then retrieved and screened by three reviewers independently (FDT, USK, NDAB). Conflicts were resolved by mutual agreement. From all included documents, we extracted information regarding study design, socio-demographic characteristics, clinical findings, type of treatment and outcome results. Results We included 28 articles in our full text retrieval. These studies totaled 1181 patients managed for cerebral aneurysm in Africa. Half (50.0%; n = 14) of all studies had been published in the past 5 years and nearly half (46.4%; n = 13) of these studies were conducted in two countries: eight in Morocco and five in South Africa, we didn’t found any publication on cerebral aneurysm for nearly 80% of African countries. Also, there was a female predominance among cerebral aneurysm study participants (62.5%), and the mean time from diagnosis to surgery was 12.1 days. Cerebral aneurysms were most often located in the internal carotid artery (29.6%) and anterior cerebral artery (23.2%). Microneurosurgery (67%) was the most widely used option in these studies ahead of coiling (7.9%). Patient outcomes were judged favorable in 64.2% of cases, and the mortality rate following surgical (open vascular and endovascular) intervention was 19.4%. Conclusion The management of intracerebral aneurysms remains suboptimal in Africa. There are few peer-reviewed reports of aneurysm practice.

The pathophysiology of subarachnoid haemorrhage

Aneurysm rupture with subarachnoid haemorrhage is the most devastating complication of intracerebral aneurysms. Grading the severity of the haemorrhage assists with prognostication and assists with decision-making for patient management. Both radiological and clinical grading systems can be predictive of outcomes following subarachnoid haemorrhage. The pathophysiology of, and risk factors for, intracerebral aneurysm formation, growth, and rupture are complicated and poorly understood. In order to make an informed judgement about which patients to treat, it is important to balance the natural history of the condition against each patient’s risks of treatment. Numerous risk factors for aneurysm rupture have been identified, and this quantification of risk continues to be refined. Cerebral vasospasm is a common complication after subarachnoid haemorrhage. The pathological mechanisms of vasospasm involve numerous changes acting in concert to result in ischaemic neurological deficits. Clinical and radiological monitoring allows early detection and treatment to prevent ischaemic neurological deficits.