Result of surgery for ruptured intracranial aneurysms in Nepal

Although aneurysmal subarachnoid haemorrhage appears to be fairly common in the developing countries, the data on the results of management appear to be relatively sparse. This is a retrospective study of 40 patients with 44 intracranial aneurysms operated upon at the National Neurosurgical Referral Centre in Kathmandu, Nepal from 1991 to 1999. The female male ratio was 1.5:1. Age ranged from 16 to 69 years with a mean of 43.2. In location, 18 (41%) were anterior communicating, 10 (23%) posterior communicating, nine (20%) middle cerebral, five (11%) internal carotid other than posterior communicating, two (5%) distal anterior cerebral and one (2%) posterior circulation. Multiple aneurysms were present in four (10%) and giant in three (8%). The timing of surgery ranged from 3 days to 3 months from the day of bleeding. Microsurgical clipping was possible in 37 (93%) and wrapping had to be done in three (7%). Overall mortality was four (10%), two (5%) had a surgery-related death and a further two (5%) died later due to pulmonary embolism. The remaining (90%) made a good recovery. The results compare favourably with that of the International Cooperative Study. Further reduction in mortality will have to await the introduction of endovascular techniques.