Objective: The purpose of this study is to evaluate the overall results of management of
patients presented with subarachnoid hemorrhage (SAH) due to rupture cerebral aneurysms
who were admitted at general hospital lacking to the standard known neurovascular surgical
facilities. Methods: The author had reviewed retrospectively the clinical characteristics of 70
patients presenting with SAH due to rupture cerebral aneurysm admitted from January 2003
to January 2008 at neurosurgical department, King Fahd Hospital, Al-Madina AlMunawarah, SA. Surgical group included 30 patients were operated upon for clipping of the
rupture aneurysm. Nonsurgical group included 25 patients were managed conservatively at
our hospital, while 10 patients transferred to higher center, and 5 patients refused surgery
anywhere. Data including clinical presentations, imaging studies, and results of management
for both groups were used to analyze the overall results. Results: In surgical patients the
results was excellent in 25 patients, good in 2, poor in one, and two patients died. Anterior
communicating artery aneurysm was predominance in surgical group. In non surgical group
20 patients died and 5 patients in persistent vegetative state. Multiple system failure, cerebral
infarction, and rebleeding were the causes for deterioration and death in non surgical
patients. The incidence of rebleeding was 5% in our patients which considered not high to be
as a main cause of deterioration in both groups of patients. Conclusion: Management of
patients with SAH due to ruptured cerebral aneurysms at general hospital with limited
neurovascular resources and facilities must be adopted to fit the actual local circumstances
and coup with culture and believing thoughts of the population. The excellent surgical results
can be achieved in selected patients with ruptured cerebral aneurysm regardless the presence
of standard high level neurovascular facilities. |
