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Gams Massi D, Pazeu MD, Motah M, Magnerou AM, Kenmegne C, Mbahé S, Mapoure NY. Spontaneous subarachnoid hemorrhage in a referral health Centre in Central Africa. eNeurologicalSci 2024; 36:100518. [PMID: 39139148 PMCID: PMC11321439 DOI: 10.1016/j.ensci.2024.100518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/03/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024] Open
Abstract
Background Spontaneous subarachnoid hemorrhage (sSAH) is a medicosurgical emergency with high morbidity and mortality. The aimed of this study was to describe the clinical features and outcome of sSAH in Cameroon. Methods We reviewed medical records of patients aged ≥15 years old, admitted for sSAH from Januray 2011 to December 2020 in the Douala General Hospital. The diagnosis of sSAH was confirmed by neuroimaging (CT scan or MRI). Clinical and radiological severities were assessed by the WFNS score and the modified Fisher score respectively. Factors associated to in-hospital mortality was identified using cross-table (RR and 95%CI). Results Among the 111 cases of sSAH reviewed in emergencies records, we included 70 patients. The mean age was of 55.6 ± 13.6 years. Female were predominant (57.1%). Altered consciousness was the main clinical feature (55.7%). The WFNS score was grade 4-5 in 54.3% of patients. And 75.7% of cases presented a modified Fisher score of 3-4. Ruptured of intracranial aneurysm was the most common etiology (46.2%). Endovascular treatment and/or surgical treatment were not avaible. Hospital-based mortality was 40% and factor associated with death were Altered consciousness (RR: 4.3, 95%CI:1.52-12.33, p = 0.004), coma (RR: 23.9, 95%CI:2.85-200.62, p = 0.004), WFNS grade 5 (RR: 18.2, 95%CI:3.7-92.3, p < 0.001), and hospital length ≤ 7 days (RR: 13.5, 95%CI:4.28-42.56, p < 0.001). Conclusion Mortality and disability of sSAH are still high in our setting. Further studies with prospective follow up of patients are needed to determine the long-term outcome of these patients.
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Affiliation(s)
- Daniel Gams Massi
- Neurology unit, Douala General Hospital, Douala, Cameroon
- Faculty of Health Sciences, University of Buea
| | - Mikael Doufiene Pazeu
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Mathieu Motah
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Annick Melanie Magnerou
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Neurology department, Douala Laquintinie Hospital, Douala, Douala, Cameroon
| | | | - Salomon Mbahé
- Neurology unit, Douala General Hospital, Douala, Cameroon
| | - Njankouo Yacouba Mapoure
- Neurology unit, Douala General Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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Lim J, Aguirre AO, Baig AA, Levy BR, Ladner LR, Crider C, Garay-Morales S, Yu Alfonzo S, Galloza D, Jaikumar V, Monteiro A, Kuo CC, Vakharia K, Lai PMR, Snyder KV, Davies JM, Siddiqui AH, Levy EI. Global Disparities in the Presentation and Management of Aneurysmal Subarachnoid Hemorrhage: A Review and Analysis. World Neurosurg 2024; 187:202-210.e4. [PMID: 38750883 DOI: 10.1016/j.wneu.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality rates. There is a significant gap in the literature describing global disparities in demographics, management, and outcomes among patients with aSAH. We aimed to conduct a systematic review and meta-analysis to assess global disparities in aSAH presentation and management. METHODS PubMed and Embase databases were queried from earliest records to November 2022 for aSAH literature. Presentation, demographics, comorbidities, treatment methods, and outcomes data were collected. Articles that did not report aSAH-specific patient management and outcomes were excluded. Pooled weighted prevalence rates were calculated. Random effects model rates were reported. RESULTS After screening, 33 articles representing 10,553 patients were included. The prevalence of Fisher grade 3 or 4 aSAH in high- and lower-income countries (HIC and LIC), respectively, was 79.8% (P < 0.01) and 84.1 (P < 0.01). Prevalence of male aSAH patients in HIC and LIC, respectively, was 35.8% (P < 0.01) and 45.0% (P < 0.01). Prevalence of treatment in aSAH patients was 99.5% (P < 0.01) and 99.4% (P = 0.16) in HIC and LIC, respectively. In HIC, 35% (P < 0.01) of aneurysms in aSAH patients were treated with coiling. No LIC reported coiling for aSAH treatment; LIC only reported rates of surgical clipping, with a total prevalence of 92.4% (P < 0.01) versus 65.6% (P < 0.01) in HIC. CONCLUSION In this analysis, we found similar rates of high-grade SAH hemorrhages in HIC and LIC but a lack of endovascular coil embolization treatments reported in LIC. Additional research and discussion are needed to identify reasons for treatment disparities and intervenable societal factors to improve aSAH outcomes worldwide.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Bennett R Levy
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Liliana R Ladner
- School of Medicine, Virginia Tech Carilion, Roanoke, Virginia, USA
| | - Corianne Crider
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Steven Garay-Morales
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Sabrina Yu Alfonzo
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Daniel Galloza
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Vinay Jaikumar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
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Dokponou YCH, Alihonou T, Adjiou DKFDP, Obame FLO, Nyalundja AD, Dossou MW, Murhega RB, Lawson LD, Badirou OBA, Kpègnon NA, Bankole NDA. Surgical Aneurysm Repair of Aneurysmal Subarachnoid Hemorrhage in Sub-Saharan Africa: The State of Training and Management. World Neurosurg 2023; 176:e485-e492. [PMID: 37257644 DOI: 10.1016/j.wneu.2023.05.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND In a resource-limited setting such as sub-Saharan African countries, neurosurgeons need training and fellowship for surgical repair of aneurysmal subarachnoid hemorrhage (aSAH). Surgical repair of ruptured aneurysms costs less and requires less instrumentation compared with endovascular procedures. The purpose of this study is to evaluate the state of training and management of aSAH in sub-Saharan Africa training centers. METHODS An e-survey was sent as a Google Form to neurosurgeons and neurosurgical trainees in neurosurgery training centers in sub-Saharan Africa; responses were accepted from September 9 to October 23, 2022. Statistical analysis was performed using Microsoft Excel and JAMOVI 3.2. RESULTS All 44 centers from 17 countries responded. Most of the respondents were neurosurgery residents (n = 30; 68.18%). The level of training on clipping was basic after completing the residency program (n = 18; 40.91%). Twenty respondents (45.45%) identified that fellowships on aneurysmal clipping and endovascular treatment are offered abroad. Thirteen participants (29.55%) indicated that endovascular treatment is available at their institutions. The most common challenges with lack of training for neurosurgical aneurysm clipping were scarce scholarship and collaboration with training centers from high-income countries (n = 33; 75%). The availability of intensive care unit beds also contributed to the presence of neurosurgical training of aneurysm clipping (12.1 ± 3.67 vs. 9.29 ± 5.82; P = 0.05). CONCLUSIONS In sub-Saharan African countries, the lack of collaborations with high-income countries for training through fellowships of young neurosurgeons for aneurysm repair seems to be the most important challenge that should be overcome.
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Affiliation(s)
- Yao Christian Hugues Dokponou
- Department of Research, Sub-Saharan African Future Neurosurgeons Association (SAFNA), Cotonou, Benin; Department of Neurosurgery, Centre National Hospitalier Universitaire Hubert Koutoukou MAGA, Cotonou, Benin.
| | - Thierry Alihonou
- Department of Research, Sub-Saharan African Future Neurosurgeons Association (SAFNA), Cotonou, Benin; Department of Neurosurgery, Centre National Hospitalier Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | | | | | - Arsene Daniel Nyalundja
- Department of Research, Sub-Saharan African Future Neurosurgeons Association (SAFNA), Cotonou, Benin; Center for Tropical Diseases and Global Health (CTDGH), Faculty of Medicine, Université Catholique de Bukavu, Democratic Republic of Congo
| | - Mèhomè Wilfried Dossou
- Department of Research, Sub-Saharan African Future Neurosurgeons Association (SAFNA), Cotonou, Benin
| | - Roméo Bujiriri Murhega
- Department of Research, Sub-Saharan African Future Neurosurgeons Association (SAFNA), Cotonou, Benin
| | - Laté Dzidoula Lawson
- Department of Research, Sub-Saharan African Future Neurosurgeons Association (SAFNA), Cotonou, Benin
| | | | - Nicaise Agada Kpègnon
- Department of Research, Sub-Saharan African Future Neurosurgeons Association (SAFNA), Cotonou, Benin
| | - Nourou Dine Adeniran Bankole
- Department of Research, Sub-Saharan African Future Neurosurgeons Association (SAFNA), Cotonou, Benin; Clinical Investigation Center (CIC), 1415, INSERM, Department of Interventional Neuroradiology, Tours University Hospital, Tours, France
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Dokponou YCH, Kotecha J, Bandyopadhyay S, Erhabor J, Ooi SZY, Egiz A, Boutarbouch M, Dalle DU, Higginbotham G, Thioub M, Sichimba D, Bankole NDA, Kanmounye US. Continental Survey of Access to Diagnostic Tools and Endovascular Management of Aneurysmal Subarachnoid Hemorrhage in Africa. Front Surg 2021; 8:690714. [PMID: 34355014 PMCID: PMC8329527 DOI: 10.3389/fsurg.2021.690714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
Rationale: Interventional neurovascular procedures are effective in lowering the burden of mortality and complications resulting from aneurysmal subarachnoid hemorrhage (aSAH). Despite the wide uptake of interventional neurovascular procedures in high-income countries, access to care in low- and middle-income countries remains limited, and little is known about accessibility in Africa. In this survey, we decided to assess access to diagnostic tools and treatment of aSAH in Africa. Methodology: A Google form e-survey was distributed to African neurosurgery centers accepting responses from January 4th to March 21st 2021. Data on accessibility to diagnostic tools, treatment methodologies, and interventional neuroradiology personnel in African centers were collected. Ninety five percent confidence intervals were computed for each variable. Results: Data was received from 36 neurosurgical centers in 16 African countries (16/54, 30%). Most centers were public institutions. Ninety four percent of the centers had the necessary resources for a lumbar puncture (LP) and a laboratory for the diagnosis of aSAH. Most centers had at least one computed tomography (CT) scanner, 81% of the centers had access to CT angiography and some had access to conventional angiography. Forty seven percent of the centers could obtain a head CT within 2 h of presentation in an emergency. Sixty one percent of centers provided clipping of intracranial aneurysms whilst only 22% of centers could perform the endovascular treatment. Sixty four percent of centers did not have an endovascular specialist. Conclusion: This survey highlights health inequity in access to endovascular treatment for aSAH. Lack of diagnostic tools to identify an aneurysm and a shortfall of qualified endovascular specialists are prime reasons for this. Our findings can inform health system strengthening policies including the acquisition of equipment and capacity building in Africa.
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Affiliation(s)
- Yao Christian Hugues Dokponou
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Department of Neurosurgery, Mohammed V University, Rabat, Morocco
| | - Jay Kotecha
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Soham Bandyopadhyay
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joshua Erhabor
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Abdullah Egiz
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - David Ulrich Dalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - George Higginbotham
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Mbaye Thioub
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Dawin Sichimba
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Nourou Dine Adeniran Bankole
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Department of Neurosurgery, Mohammed V University, Rabat, Morocco
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Thioub M, Mbaye M, Thiam AB, Zirhumana C, Sy C, Ndoye N, Ba MC, Badiane SB. Microsurgical Treatment of Ruptured Intracranial Aneurysms in Sub-Saharan Africa: A Series of 102 Consecutive Cases Treated in Senegal. World Neurosurg 2017; 110:226-231. [PMID: 29158093 DOI: 10.1016/j.wneu.2017.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In sub-Saharan Africa, the management of ruptured intracranial aneurysms (RIAs) is difficult for many reasons. In this retrospective, 3-year study, the authors will demonstrate the particularities of the management of RIAs in Senegal. METHODS We analyzed retrospectively 102 consecutive cases of RIAs operated on between May 2013 and December 2016 in Neurosurgical Department of Fann Hospital in Dakar, Senegal. Patients characteristics, imaging results, aneurysms, treatment, and outcome were analyzed. RESULTS One hundred two cases were operated in this 3-year period of a total of 129 cases of RIAs received in our department in the same period. A total of 65% of the patients were female. According to the World Federation of Neurosurgical Societies (WFNS) scale, 49% were WFNS I, and 33% WFNS III. Fisher scale showed 29% of Fisher 2 and 45% of Fisher 4. The aneurysms were located on anterior communicating complex in 38%, on the internal carotid artery in 28%, on the middle cerebral artery in 27% of cases and on posterior circulation in 9 cases. The pterional approach was used in 93 cases. According to the modified Rankin Scale, 67 patients (65.6%) had good outcome, 22 (21.5%) had poor outcome, and the mortality rate was 12.7% (13 patients) at last follow-up. CONCLUSIONS This study demonstrates encouraging results if one refers to the global patient postoperative outcomes. However, the large number of patients not undergoing treatment also requires us to improve preoperative management conditions.
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Affiliation(s)
- Mbaye Thioub
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal.
| | - Maguette Mbaye
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal
| | | | | | - Cheikh Sy
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal
| | - Ndaraw Ndoye
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal
| | - Momar Codé Ba
- Neurosurgery Department, Fann Teaching Hospital, Dakar, Senegal
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