Surgical Case Presentations

This is the main chapter of the book. The management of ruptured aneurysms in central Africa is described through a number of representative cases. Most of the patients had a subarachnoid hemorrhage some weeks to months before microsurgical clipping. The tissue around the aneurysm is adherent to it and needs a very careful dissection in order to establish a clear plane to place the aneurysm clip safely. Stenosing arteries with the clips as well as successful aneurysm clip occlusion have to be assured visually, since ICG or micro-Doppler are not available. When the position of the blades cannot be seen (behind the aneurysm sack), the aneurysm has to be cut out. The blades have to be away from any arteries in order to avoid stenoses. The number and shape of the clips have to be used wisely, since there are only a few clips available. We provide a step-by-step illustration of the management of microsurgical clipping when working with a limited equipment in central Africa.