Installation of a vascular neurosurgery activity based on the clipping of ruptured intracranial aneurysms at the Senegal army training hospital: preliminary study

Abstract Introduction Subarachnoid hemorrhage due to rupture of a cerebral aneurysm is a severe pathology with a mortality rate of 51% and functional dependence in one-third of survivors. The absence of endovascular treatment of cerebral aneurysms in our context makes mastery of surgical clipping imperative. We report our experience and preliminary results of the implementation of a vascular neurosurgery activity focused on the surgical treatment of ruptured intracranial aneurysms in the neurosurgery department of “Hôpital Principal de Dakar”-the Senegalese army's training hospital. Patients and methods We conducted a retrospective study of 21 descriptive cases of patients who received surgical treatment for a ruptured cerebral aneurysm between May 2019 and April 2024. After assigning a young vascular neurosurgeon to the team, this activity was made possible with the help of a national referent and Senegalese mentor vascular neurosurgeon. Results Our patients' average age was 48.62 years, with extremes of 15 and 70 years, and the sex ratio was 0.9. The admission time was 1.9 days, and WFNS (World Federation of Neurosurgical Societies) 3 and 4 scores were found in four (19.1%) and three (14.3%) cases, respectively. The modified Fisher score was 4 in 11 cases (52.4%), including a compressive Sylvian hematoma. On cerebral computed–tomography angiography, three patients (14.3%) had multiple aneurysms. The mean time to surgery was 11.45 days. An intraoperative rupture of the aneurysm was found in 6 cases or 28.6%, and temporary clipping was performed in 13 patients (61.9%). The postoperative death rate was 33.3%. After a minimum of six months of follow-up, 12 patients (57.1%) had an mRS (modified Rankin score) of less than or equal to 2. Conclusion Mastery in microsurgical clipping of cerebral aneurysms requires reinforced theoretical teaching, preferably with the support of an experienced mentor, in order to reduce the learning curve.