Treatment of ruptured anterior communicating artery aneurysm accompanying intracerebral hematomas: endovascular coiling followed by hematoma evacuation with burr hole trephination and catheterization

Chung, Joonho; Kim, Byung Moon; Shin, Yong Sam; Lim, Yong Cheol; Park, Soo Young

doi:10.1007/s00701-009-0328-z

Cited by 10 publications

(8 citation statements)

References 11 publications

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“…Coiling also eliminates the need for cerebral dissection, to expose the aneurysm, and to cerebral retraction. 4,6–8…”

Section: Discussionmentioning

confidence: 99%

“…For these aneurysms locations, the ICH volumes were smaller than for ICH, due to rupture of the MCA aneurysm, which is consistent with previous studies. 7 We can think that rupture of ICA and ACA aneurysms are most often treated by coiling first, because the ICH is smaller and the clinical presentation is better than a rupture of MCA, with a bigger ICH.…”

Section: Discussionmentioning

confidence: 99%

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Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases

et al. 2015

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Background Aneurysmal subarachnoid haemorrhage (ASH) with intracerebral hematoma (ICH) has a poor prognosis. The treatment is to secure the aneurysm and do an ICH evacuation. Objective The aim of the study was to determine if aneurysm coiling followed by ICH evacuation is a viable alternative treatment compared to exclusive surgery, regardless of the clinical or paraclinical presentations. Methods A retrospective study was conducted between 2004 and 2014, which included 44 patients. The patients were divided up in four groups. Two were principal groups: The clipped group (aneurysm clipping with ICH evacuation) and the coiled group (aneurysm coiling, followed by ICH evacuation); and two were subgroups of the latter: Aneurysm coiling with ICH evacuation after 24 hours and ICH evacuation followed by aneurysm coiling. We studied the demographic and radiologic characteristics, and the 3-month outcome. Results We included 17 patients in the coiled group: The outcome was better for the patients with World Federation of Neurosurgery (WFNS) scores of 1, 2 and 3; compared to the patients with WFNS scores 4 and 5. We included 16 patients in the clipped group: The outcome was better, compared the coiled group, for those patients with WFNS scores 4 and 5. Six patients were treated with aneurysm coiling, followed by ICH evacuation after 24 hours: 33% had a good outcome. Five patients were treated by ICH evacuation, followed by aneurysm coiling: None had a good outcome. Conclusions It was necessary to realise a prospective study to compare the outcomes of patients with WFNS scores of 1, 2 or 3; between those with aneurysm coiling followed by ICH evacuation and aneurysm clipping with ICH evacuation, to determine the potential of using the coiling first, for these patients.

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“…Coiling also eliminates the need for cerebral dissection, to expose the aneurysm, and to cerebral retraction. 4,6–8…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases

et al. 2015

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“…In 2009, Chung et al reported trying the same strategy in patients with ruptured A-com aneurysms. 9) In this series, they reported better outcomes: there was no mortality, and the favorable outcomes were 66.7%. They have suggested that this strategy is a good alternative, but only for A-com aneurysms with ICH, and not for other aneurysms.…”

Section: Discussionmentioning

confidence: 56%

“…Alternative methods with better outcomes have been reported by Niemann et al, 35) who introduced endovascular treatment for ruptured aneurysms followed by hematoma evacuation, and Chung et al, 9) who introduced endovascular treatment for ruptured anterior communicating artery (A-com) aneurysms, followed by burr-hole trephination, catheterization, and hematoma drainage. In both studies, the patients did not show signs of deterioration, and did not need immediate surgical decompression.…”

Section: Introductionmentioning

confidence: 99%

“…In both studies, the patients did not show signs of deterioration, and did not need immediate surgical decompression. We believed that the technique used by Chung et al 9) to treat the ruptured A-com aneurysms could be applied to treat other ruptured aneurysms with ICH or ISH. Hence, we adapted this less-invasive strategy of endovascular treatment for ruptured aneurysms, followed by stereotactic aspiration of hematoma (SRH; stereotactic removal of hematoma) using urokinase, to all types of ruptured aneurysms.…”

Section: Introductionmentioning

confidence: 99%

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A Less Invasive Strategy for Ruptured Cerebral Aneurysms with Intracerebral Hematomas: Endovascular Coil Embolization Followed by Stereotactic Aspiration of Hematomas Using Urokinase

Kim

Kong

2017

J Cerebrovasc Endovasc Neurosurg

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ObjectiveAneurysm clipping and simultaneous hematoma evacuation through open craniotomy is traditionally recommended for ruptured cerebral aneurysms accompanied by intracerebral or intrasylvian hemorrhages. We report our experience of adapting a less invasive treatment strategy in poor-grade patients with intracerebral or intrasylvian hemorrhages associated with ruptured cerebral aneurysms, where the associated ruptured cerebral aneurysms were managed by endovascular coil embolization, followed by stereotactic aspiration of hematomas (SRH) using urokinase.Materials and MethodsWe retrospectively analyzed 112 patients with ruptured cerebral aneurysms. There were accompanying intracerebral or intrasylvian hemorrhages in 36 patients (32.1%). The most common site for these ruptured aneurysms was the middle cerebral artery (MCA) (n = 15; 41.6%). Endovascular coil embolization followed by SRH using urokinase was performed in 9 patients (25%).ResultsIn these 9 patients, the most common site of aneurysms was the MCA (n = 3; 33.4%); the hematoma volume ranged from 19.24 to 61.68 mL. Four patients who were World Federation of Neurological Surgeons (WFNS) grade-IV on admission, achieved favorable outcomes (Glasgow Outcome Score [GOS] 4 or 5) at 6-months postoperatively. In the five patients who were WFNS grade-V on admission, one achieved a favorable outcome, whereas 4 achieved GOS scores of 2 or 3, 6-months postoperatively. There was no mortality.ConclusionIf immediate hematoma evacuation is not mandated by clinical or radiological signs of brain herniation, a less invasive strategy, such as endovascular coil embolization followed by SRH using urokinase, may be a good alternative in poor-grade patients with intracerebral or intrasylvian hemorrhages associated with ruptured cerebral aneurysms.

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Surgical Management of Aneurysmal Hematomas: Prognostic Factors and Outcome

Meneghelli

Cozzi

Hasanbelliu

et al. 2016

Acta Neurochirurgica Supplement

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From 1991 until 2013, 304 patients with intracranial hematomas from aneurysmal rupture were managed surgically in our department, constituting 17 % of all patients with aneurysmal rupture. Of them, 242 patents presented with isolated intracerebral hematomas (in 69 cases associated with significant intraventricular hemorrhage), 50 patients presented with combined intracerebral and subdural hematomas (in 11 cases associated with significant intraventricular hemorrhage), and 12 presented with an isolated subdural hematoma. The surgical procedure consisted of simultaneous clipping of the aneurysm and evacuation of the hematoma in all cases. After surgery, 16 patients (5 %) submitted to an additional decompressive hemicraniectomy, and 66 patients (21 %) submitted to a ventriculo-peritoneal shunt. Clinical outcomes were assessed at discharge and at 6 months, using the modified Rankin Scale (mRS); a favorable outcome (mRS 0-2) was observed in 10 % of the cases at discharge, increasing to 31 % at 6 months; 6-month mortality was 40 %. Applying uni- and multivariate analysis, the following risk factors were associated with a significantly worse outcome: age >60; preoperative Hunt-Hess grades IV-V; pupillary mydriasis (only on univariate); midline shift >10 mm; hematoma volume >30 cc; and the presence of hemocephalus (i.e., packed intraventricular hemorrhage). Based on these results, an aggressive surgical treatment should be adopted for most cases with aneurysmal hematomas, excluding patients with bilateral mydriasis persisting after rescue therapy.

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Treatment of ruptured anterior communicating artery aneurysm accompanying intracerebral hematomas: endovascular coiling followed by hematoma evacuation with burr hole trephination and catheterization

Cited by 10 publications

References 11 publications

Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases

Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases

A Less Invasive Strategy for Ruptured Cerebral Aneurysms with Intracerebral Hematomas: Endovascular Coil Embolization Followed by Stereotactic Aspiration of Hematomas Using Urokinase

Surgical Management of Aneurysmal Hematomas: Prognostic Factors and Outcome

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