Intracranial Aneurysm Surgery in Southeast Nigeria: Experience and Challenges from Neurosurgical Management.

Background: Intracranial aneurysms (IAs) remain underreported in sub-Saharan Africa, with limited data on neurosurgical management, challenges and outcomes. This study aimed to document the clinical experience and challenges of IA management at a tertiary neurosurgical centre in Southeast Nigeria. This study presents the first institutional experience of intracranial aneurysm surgery in Southeast Nigeria. Methods: We conducted a nine-year retrospective cohort review (2015–2023) of computed tomography angiography (CTA/MRA)-confirmed intracranial aneurysms managed at our centre. Data extracted included demographics, clinical presentation, aneurysm characteristics, surgical approaches, intra- and post-operative challenges, and outcomes. Results: Fifty-eight patients with intracranial aneurysms were managed (female-male ratio 2.5:1), of whom 35 underwent surgery. The mean age was 42.3 ±12.1 years. Of the 58 patients, 32.8% were <40 years, and 55.2% had admission systolic BP >160mmHg. All presented with subarachnoid hemorrhage, predominantly from posterior communicating artery aneurysms (53.4%). World Federation of Neurosurgical Societies (WFNS) grades were 0–2 in 48.3% and 3–5 in 51.7%. CTA-based aneurysm size was <11mm in 15 (42.9%) (four of these had bigger dimension at surgery) and > 25 mm 7 (20.0%). Delay from presentation to surgery was < 3 days in 9 (25.7%), 4-7 days in 14 (40.0%), > 7 days in 12 (34.3%). Successful surgical clipping was performed in 94.3% of cases and common carotid artery ligation in 1 case. Intraoperative challenges included brain oedema (25.7%), rupture (22.9%), and vasospasm (11.4%). Postoperative complications included delayed ischemic neurologic deficit (34.3%) and hydrocephalus (31.5%). Post-operative mortality was 17.1% (6/35) while overall in-hospital mortality occurred in six patients (10.3%). Conclusion: Our experience revealed that younger patients with hypertension predominated, with posterior communicating artery aneurysms being most common. Neurosurgeons should be conscious of the study's highlighted intra- and post-operative challenges during surgical planning. High complication rates underscore the need for improved preoperative planning and postoperative monitoring in resource-limited settings.