Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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A Less Invasive Approach for Ruptured Aneurysm with Intracranial Hematoma: Coil Embolization Followed by Clot Evacuation

Jeong, Je-Hoon;Koh, Jun-Seok;Kim, Eui-Jong

  • Published : 20070200
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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 two. Surgical evacuation of the clot was done immediately after the endovascular coil placement. The treatment results were a Glasgow Outcome Scale score 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 valuable alternative treatment for this patient group, and this warrants further investigation.

Keywords

References

  1. Abbed KM, Oglivy CS. Intracerebral hematoma from aneurysm rupture. Neurosurg Focus 2003;15:E4
  2. Baltsavias GS, Byrne JV, Halsey J, Coley SC, Sohn MJ, Molyneux AJ. Effects of timing of coil embolization after aneurysmal subarachnoid hemorrhage on procedural morbidity and outcomes. Neurosurgery 2000;47:1329-1331
  3. Birchall D, Khangure M, McAuliffe W, Apsimon H, Knuckey N. Endovascular management of acute subarachnoid haemorrhage in the elderly. Br J Neurosurg 2001;15:35-38 https://doi.org/10.1080/026886901300004067
  4. Byrne JV, Adams CB, Kerr RS. Endosaccular treatment of inoperable intracranial aneurysms with platinum coils. Br J Neurosurg 1995;9:585-592
  5. Drake CG. Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg 1988;68:985-986(Letter)
  6. Gonzalez N, Murayama Y, Nien YL, Martin N, Frazee J, Duckwiler G, et al. Treatment of unruptured aneurysms with GDCs: clinical experience with 247 aneurysms. AJNR Am J Neuroradiol 2004;25:577-583
  7. Hauerberg J, Eskesen V, Rosenorn J. The prognostic significance of intracerebral hematoma as shown on CT scanning after aneurysmal subarachnoid haemorrhage. Br J Neurosurg 1994;8:333-339 https://doi.org/10.3109/02688699409029622
  8. Heiskanen O, Poranen A, Kuurne T, Valltonen S, Kaste M. Acute surgery for intracerebral haematomas caused by rupture of an intracranial arterial aneurysm. A prospective randomized study. Acta Neurochir 1988;90:81-83 https://doi.org/10.1007/BF01560559
  9. Niemann DB, Wills AD, Maartens NF, Kerr RS, Byrne JV, Molyneux AJ. Treatment of intracranial hematomas caused by aneurysm rupture: coil placement followed by clot evacuation. J Neurosurg 2003;99:843-847
  10. Nowak G, Schwachenwald D, Schwachenwald R, Kehler U, Muller H, Arnold H. Intracerebral hematomas caused by aneurysm rupture. Experience with 67 cases. Neurosurg Rev 1998;21:5-9 https://doi.org/10.1007/BF01111478
  11. Rowe JG, Molyneux AJ, Byrne JV, Renowden S, Aziz TZ. Endovascular treatment of intracranial aneurysms: a minimally invasive approach with advantages for elderly patients. Age Ageing 1996;25:372-376
  12. Shimoda M, Oda S, Mamata Y, Tsugane R, Sato O. Surgical indications in patients with an intracerebral hemorrhage due to ruptured middle cerebral artery aneurysm. J Neurosurg 1997;87:170-175 https://doi.org/10.3171/jns.1997.87.2.0170
  13. Tokuda Y, Inagawa T, Katoh Y, Kumano K, Ohbayashi N, Yoshioka H. Intracerebral hematoma in patients with ruptured cerebral aneurysms. Surg Neurol 1995;43:272-277
  14. Vinuela F, Duckwiler G, Mawad M. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 1997;86:475-482