Characteristics and outcomes of surgical clipping of ruptured intracranial aneurysms at a tertiary care institution in Trinidad & Tobago – a descriptive report

Abstract

ABSTRACT Objectives Reports on the management and outcomes of intracranial aneurysms are sparse from the English-Speaking Caribbean. This study aimed to determine the characteristics and outcomes of surgically clipped ruptured intracranial aneurysms undertaken by a single neurosurgeon, under the unique challenges faced in a low-resources setting. Methods The neurosurgical operative logbook from the period July 1st 2018 - July 31st 2021 was examined to identify all patients who had surgically clipped cerebral aneurysms at a tertiary care teaching hospital in Trinidad and Tobago. Patients’ charts were reviewed to assess risk factors such as hypertension, smoking, positive family history, aneurysm grades and types, including presenting Hunt and Hess (HH) Grade, modified Fisher CT Grade, time to definitive surgery and Glasgow Outcome Scale - extended (GOSE). Results Twenty-six patients underwent open surgical aneurysmal clipping, between the ages of 20 – 73 years. Posterior communicating artery aneurysms (35%) and anterior communicating artery aneurysms (38%) were the most commonly encountered types of aneurysms. One half of patients were HH Grade 1, and 58% were Fisher Grade 4. Time to clipping ranged from 3 – 62 days, with a mean of 12 days. About 42% of aneurysms were clipped prior to the peak vasospasm period, while 61% were clipped within 14 days. Following the procedure, 62% of patients had GOSE score of 8 (maximum function). Conclusion Surgical clipping of ruptured intracranial aneurysms may yield good patient outcomes even in a low-resource setting, despite challenges faced due to limited resources and operating time. Clipping during peak vasospasm period did not result in worse outcomes. The establishment of a neurovascular service may be beneficial even in low-resource settings. Keywords Intracranial aneurysm; clipping; endovascular; Trinidad and Tobago; Caribbean