Korean J Radiol.  2007 Feb;8(1):2-8. 10.3348/kjr.2007.8.1.2.

A Less Invasive Approach for Ruptured Aneurysm with Intracranial Hematoma: Coil Embolization Followed by Clot Evacuation

• Jeong JH
• Koh JS
• Kim EJ

• KMID: 753859
• DOI: http://doi.org/10.3348/kjr.2007.8.1.2

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.

Keyword

Endovascular coil embolization; Aneurysmal rupture; Intracerebral hemorrhage; Alternative treatment

MeSH Terms

Treatment Outcome
Tomography, X-Ray Computed
Retrospective Studies
Middle Aged
Male
Intracranial Aneurysm/radiography/*therapy
Humans
Hematoma/radiography/*therapy
Female
Embolization, Therapeutic/*methods
Drainage/*methods
Cerebral Angiography
Aneurysm, Ruptured/radiography/*therapy
Adult

Figure

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  Fig. 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).

• 

  Fig. 2 Brain CT shows all cisternal subarachnoid hemorrhage and left temporal lobe intracerebral hemorrhage with a mass effect by ipsilateral ventricle compression (A). Left cerebral angiogram demonstrates middle cerebral artery bifurcation aneurysm projecting superior-laterally with shifting of M2 portion (B), and occluded sac after coil embolization (C). The postoperative 6 month brain CT illustrates coil inserted state in the sac and encephalomalatic change in the temporal lobe (D).

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