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A less invasive approach for ruptured aneurysm with intracranial hematoma: coil embolization followed by clot evacuation.

Jeong JH, Koh JS, Kim EJ - Korean J Radiol (2007 Jan-Feb)

Bottom Line: Endovascular coil embolization is a useful alternative procedure to reduce the surgical morbidity and mortality rates.The treatment results were a Glasgow Outcome Scale score of good recovery and moderate disability in six patients (66.7%).No mortality was recorded and no procedural morbidity was incurred by both the endovascular and direct craniotomy procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kyung-Hee University, College of Medicine, Seoul 130-701, Korea.

ABSTRACT

Objective: The presence of an intracerebral hematoma from a ruptured aneurysm is a negative predictive factor and it is associated with high morbidity and mortality rates even though clot evacuation followed by the neck clipping is performed. Endovascular coil embolization is a useful alternative procedure to reduce the surgical morbidity and mortality rates. We report here on our experiences with the alternative option of endovascular coil placement followed by craniotomy for clot evacuation.

Materials and methods: Among 312 patients who were admitted with intracerebral subarachnoid hemorrhage during the recent three years, 119 cases were treated via the endovascular approach. Nine cases were suspected to show aneurysmal intracerebral hemorrhage (ICH) on CT scan and they underwent emergency cerebral angiograms. We performed immediate coil embolization at the same session of angiographic examination, and this was followed by clot evacuation.

Results: Seven cases showed to have ruptured middle cerebral artery (MCA) aneurysms and two cases had internal carotid artery aneurysms. The clinical status on admission was Hunt-Hess grade (HHG) IV in seven patients and HHG III in two. Surgical evacuation of the clot was done immediately after the endovascular coil placement. The treatment results were a Glasgow Outcome Scale score of good recovery and moderate disability in six patients (66.7%). No mortality was recorded and no procedural morbidity was incurred by both the endovascular and direct craniotomy procedures.

Conclusion: The results indicate that the coil embolization followed by clot evacuation for the patients with aneurysmal ICH may be a less invasive and quite a valuable alternative treatment for this patient group, and this warrants further investigation.

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Related in: MedlinePlus

Brain CT shows cisternal subarachnoid hemorrhage and right frontal intracerebral hemorrhage with a mass effect, and an enhanced round mass lesion is seen at the right distal internal carotid artery (A). The emergency right internal carotid artery angiogram demonstrates an aneurysm on the dorsal surface of the internal carotid artery (B). The anterior cerebral artery is shifted, and we occluded the aneurysm with endovascular coil embolization (C). The postoperative three month brain CT shows the coil mass in the aneurysm and small encephalomalatic changes in the right frontal lobe that was previously occupied with a large hematoma (D).
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Figure 1: Brain CT shows cisternal subarachnoid hemorrhage and right frontal intracerebral hemorrhage with a mass effect, and an enhanced round mass lesion is seen at the right distal internal carotid artery (A). The emergency right internal carotid artery angiogram demonstrates an aneurysm on the dorsal surface of the internal carotid artery (B). The anterior cerebral artery is shifted, and we occluded the aneurysm with endovascular coil embolization (C). The postoperative three month brain CT shows the coil mass in the aneurysm and small encephalomalatic changes in the right frontal lobe that was previously occupied with a large hematoma (D).

Mentions: A 41-year-old male patient, with as HHG III when admitted, had SAH in the basal cistern and in the right sylvian fissure, and he had ICH in the right frontal lobe (Fig. 1A). As he was suspected of having ICH caused by aneurysmal rupture, an emergency cerebral angiography was performed; a 10 × 11 mm sized aneurysm at the dorsal wall of the right internal carotid artery was found. Coil embolization was subsequently performed (Figs. 1B, C). He was discharged without any major complication; 21 months later, he was graded as GR (Fig. 1D) and is doing well independently.


A less invasive approach for ruptured aneurysm with intracranial hematoma: coil embolization followed by clot evacuation.

Jeong JH, Koh JS, Kim EJ - Korean J Radiol (2007 Jan-Feb)

Brain CT shows cisternal subarachnoid hemorrhage and right frontal intracerebral hemorrhage with a mass effect, and an enhanced round mass lesion is seen at the right distal internal carotid artery (A). The emergency right internal carotid artery angiogram demonstrates an aneurysm on the dorsal surface of the internal carotid artery (B). The anterior cerebral artery is shifted, and we occluded the aneurysm with endovascular coil embolization (C). The postoperative three month brain CT shows the coil mass in the aneurysm and small encephalomalatic changes in the right frontal lobe that was previously occupied with a large hematoma (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626701&req=5

Figure 1: Brain CT shows cisternal subarachnoid hemorrhage and right frontal intracerebral hemorrhage with a mass effect, and an enhanced round mass lesion is seen at the right distal internal carotid artery (A). The emergency right internal carotid artery angiogram demonstrates an aneurysm on the dorsal surface of the internal carotid artery (B). The anterior cerebral artery is shifted, and we occluded the aneurysm with endovascular coil embolization (C). The postoperative three month brain CT shows the coil mass in the aneurysm and small encephalomalatic changes in the right frontal lobe that was previously occupied with a large hematoma (D).
Mentions: A 41-year-old male patient, with as HHG III when admitted, had SAH in the basal cistern and in the right sylvian fissure, and he had ICH in the right frontal lobe (Fig. 1A). As he was suspected of having ICH caused by aneurysmal rupture, an emergency cerebral angiography was performed; a 10 × 11 mm sized aneurysm at the dorsal wall of the right internal carotid artery was found. Coil embolization was subsequently performed (Figs. 1B, C). He was discharged without any major complication; 21 months later, he was graded as GR (Fig. 1D) and is doing well independently.

Bottom Line: Endovascular coil embolization is a useful alternative procedure to reduce the surgical morbidity and mortality rates.The treatment results were a Glasgow Outcome Scale score of good recovery and moderate disability in six patients (66.7%).No mortality was recorded and no procedural morbidity was incurred by both the endovascular and direct craniotomy procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kyung-Hee University, College of Medicine, Seoul 130-701, Korea.

ABSTRACT

Objective: The presence of an intracerebral hematoma from a ruptured aneurysm is a negative predictive factor and it is associated with high morbidity and mortality rates even though clot evacuation followed by the neck clipping is performed. Endovascular coil embolization is a useful alternative procedure to reduce the surgical morbidity and mortality rates. We report here on our experiences with the alternative option of endovascular coil placement followed by craniotomy for clot evacuation.

Materials and methods: Among 312 patients who were admitted with intracerebral subarachnoid hemorrhage during the recent three years, 119 cases were treated via the endovascular approach. Nine cases were suspected to show aneurysmal intracerebral hemorrhage (ICH) on CT scan and they underwent emergency cerebral angiograms. We performed immediate coil embolization at the same session of angiographic examination, and this was followed by clot evacuation.

Results: Seven cases showed to have ruptured middle cerebral artery (MCA) aneurysms and two cases had internal carotid artery aneurysms. The clinical status on admission was Hunt-Hess grade (HHG) IV in seven patients and HHG III in two. Surgical evacuation of the clot was done immediately after the endovascular coil placement. The treatment results were a Glasgow Outcome Scale score of good recovery and moderate disability in six patients (66.7%). No mortality was recorded and no procedural morbidity was incurred by both the endovascular and direct craniotomy procedures.

Conclusion: The results indicate that the coil embolization followed by clot evacuation for the patients with aneurysmal ICH may be a less invasive and quite a valuable alternative treatment for this patient group, and this warrants further investigation.

Show MeSH
Related in: MedlinePlus