Results of surgery for ruptured intracranial aneurysms: the experience at King Khalid University Hospital

Objectives : To provide information about the results of surgery for ruptured intracranial aneurysm in Saudi Arabia. Methods : A review was carried out of 40 consecutive cases, where patients had surgery at King Khalid University Hospital beween 1984 and 1993. Results : Only 48% of patients were Saudis. The median age of the patients was 37 years and the male to female ratio was 1.4 :1. Arrival at the neurosurgical unit ranged from 1 to 60 (median 8) days after bleed. On addition 70% of patients were in Hunt and Hess grades I and II, while 30% rebled before surgery. Only 65% of patients were treated with nimodipine which was started after arrival in our unit. There was angiographic evidence of spasm in 48% of patients. The anterior communicating artery was the most common location (50%). Due to the late arrival of patients, only 28% had early and intermediate surgery. Satisfactory clipping of the neck of aneurysm was achieved in 95%, the others were wrapped. At 6 months follow-up 78% made a good recovery (back to normality), 8% a fair recovery (moderately disabled but independent), 5% a poor recovery (severely disabled and dependent) and 10% died. The presence of angiographic spasm preoperatively proved to be a poor prognostic factor. Conclusion : The results of intracranial aneurysmal surgery in Saudi Arabia are comparable with what is reported in the literature. Early referral of patients with ruptured aneurysms to the neurosurgical unit is strongly advised.