Presentation, management and outcomes of ruptured intracranial aneurysms in Africa: A systematic review and meta-analysis

Background

Approximately two percent of the world’s population are affected by intracranial aneurysms (IAs). This study aimed to evaluate literature regarding presentation, treatment and outcomes of ruptured IAs in Africa.

Methods

A systematic review of the literature using PubMed/MEDLINE, SCOPUS, Web of Science and Google Scholar databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Twenty-one retrospective studies with 1,109 patients and 11 case reports (10 countries) were included. The mean Methodological Index for Nonrandomized Studies (MINORS) for included articles was 9.1 ± 2.5. The mean age was 43.3 years (95 %CI: 37.8–48.8), with 58.4 % (342/586) female patients. WFNS/H&H grade 1 was reported in 41.2 % (98/238) of cases and Fischer grade 2 was reported in 30.4 % (98/322) of cases. CT angiography was utilized in 94.6 % (560/592, 12 articles). The ICA was reported in 24.5 % of cases (CI: 12.9 %-36.1 %). AComA and MCA were affected in 21.2 % (95 %CI: 15.2–27.2 %) and 21.3 % (95 %CI: 15.2–27.2 %) of cases, respectively. The odds of ruptured aneurysms in the anterior circulation were 14.3 (CI: 6.3–32.2). Surgical clipping was reported in 75.0 % (448/597) and coiling in 20.4 % (122/597) across 13 studies. 66.8 % (95 %CI: 57.4–76.3 %) of patients experienced neurological improvement with a mortality rate of 12.3 % (95 %CI: 7.5–17.1 %) at last follow-up.

Conclusion

Ruptured IAs are small and located in the anterior circulation. The lack of detailed aneurysm size reporting hampers the identification of a critical rupture size for management. More research is needed to understand aneurysm characteristics and predictors of rupture in Africa.