Background: Aneurysmal subarachnoid hemorrhage (aSAH) management across the diverse healthcare landscapes of the Middle East and North Africa (MENA) region requires evidence-based guidelines adapted to varying resource levels. The MENA Stroke and Interventional Neurotherapies Organization (MENA-SINO) developed these guidelines to address critical regional challenges while maintaining core principles of care.

Methods: We adapted evidence from multiple international guidelines (AHA/ASA, ESO, NICE, Neurocritical Care Society, Chinese guidelines) using a systematic approach including: comprehensive evidence review, multidisciplinary expert panel input, regional implementation barrier assessment, and formal consensus procedures. Recommendations employ MENA-SINO's framework with modified Class of Recommendation,  ...