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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.

Authors
Chung, J; Kim, BM; Shin, YS; Lim, YC; Park, SK
Citation
Acta neurochirurgica, 151(8):917-923, 2009
Journal Title
Acta neurochirurgica
ISSN
0001-62680942-0940
Abstract
INTRODUCTION: The aim of this study was to evaluate the outcome of endovascular coiling of ruptured anterior communicating artery (AcomA) aneurysms followed by intracerebral hematoma (ICH) evacuation with burr hole trephination and catheterization. METHODS: Twelve patients treated by coiling with subsequent ICH drainage with burr hole trephination and catheterization were recruited from 290 patients with ruptured AcomA aneurysm in our hospital between January 2001 and June 2007. The clinical and radiographic characteristics and outcomes of the 12 patients were retrospectively analyzed. RESULTS: All 12 patients were male, aged from 29 to 62 years, and had ICHs with 16-ml to 45-ml volumes; nine (75%) of them had frontal ICHs on the opposite side of the dominant A1. Admission Hunt-Hess (HH) grade was 4 in eight patients, 3 in two, and 5 in two. The treatment outcomes in 8 of the 12 patients were good recovery or moderately disabled (Glasgow Outcome Scale; GOS 5 or 4), and functionally dependent (GOS 3 or 2) in the other 4 patients at the 6-month clinical follow-up. There was no rebleeding during the follow-up (mean, 22.9 months; range, 7 to 68 months). CONCLUSION: The result of our series suggests that coiling with subsequent evacuation of the ICH with burr hole trephination and catheterization may be an alternative treatment option for ruptured AcomA aneurysm with an ICH requiring evacuation on the opposite side of the dominant A1.
MeSH terms
AdultAnterior Cerebral Artery/pathologyAnterior Cerebral Artery/radiographyAnterior Cerebral Artery/surgeryCatheterization/instrumentationCatheterization/methods*Cerebral Hemorrhage/etiologyCerebral Hemorrhage/radiographyCerebral Hemorrhage/surgery*Circle of Willis/pathologyCircle of Willis/radiographyCircle of Willis/surgery*Embolization, Therapeutic/instrumentationEmbolization, Therapeutic/methods*FemaleFollow-Up StudiesGlasgow Outcome ScaleHumansIntracranial Aneurysm/complicationsIntracranial Aneurysm/radiographyIntracranial Aneurysm/surgery*MaleMiddle AgedProstheses and ImplantsTimeTreatment OutcomeTrephining/methods*Vascular Surgical Procedures/instrumentationVascular Surgical Procedures/methods
DOI
10.1007/s00701-009-0328-z
PMID
19390774
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Neurosurgery
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