Format

Send to:

Choose Destination
See comment in PubMed Commons below
World Neurosurg. 2010 Dec;74(6):626-31. doi: 10.1016/j.wneu.2010.06.051.

Coiling of ruptured aneurysms followed by evacuation of hematoma.

Author information

  • 1Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA.

Abstract

OBJECTIVE:

To report a series of patients with aneurysmal subarachnoid hemorrhage (SAH) and associated intracranial hematoma (ICH) who underwent coiling of the aneurysm followed immediately by open surgical decompression with evacuation of the hematoma.

METHODS:

With the hypothesis that aneurysm coiling before hematoma evacuation may simplify surgery, prospectively collected data at two neurovascular institutions were retrospectively reviewed. Patients with aneurysmal SAH and associated ICH who underwent combined endovascular and open surgery were identified; only cases of coiling before open surgery were analyzed. Relevant information was collected from medical records and imaging studies for analysis. The Glasgow Outcome Scale (GOS) was used to evaluate clinical outcome.

RESULTS:

There were 30 patients who were treated with endovascular obliteration of aneurysms followed by surgical decompression (9 men and 21 women; mean age 50 years). Patients presented with Hunt and Hess (H&H) grade 3 or higher except for one patient who presented initially with grade 1 and deteriorated to grade 5 after rerupture and before treatment. At discharge, GOS scores were as follows: 1 in 5 patients, 2 in 1 patient, 3 in 22 patients, and 4 in 2 patients. At a mean follow-up of 18 months (range 3-60 months), 28 patients had an outcome that could be evaluated, and GOS scores were as follows: 1 in 6 patients, 3 in 5 patients, 4 in 8 patients, and 5 in 9 patients. One patient required retreatment for aneurysm recurrence; no patient had aneurysm rerupture.

CONCLUSIONS:

In selected patients with aneurysmal SAH and associated ICH, reasonable outcomes can be achieved using aggressive control of intracranial pressure (ICP) with combined endovascular and open surgical techniques. Endovascular aneurysm obliteration before surgical decompression represents a paradigm in the management of ruptured aneurysms associated with ICH and can transform surgery to a simple decompression. In expert hands, consecutive procedures can be performed rapidly with 60.7% of patients having a favorable outcome (GOS score of 4 or 5) and becoming independent.

Copyright © 2010 Elsevier Inc. All rights reserved.

PMID:
21492630
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk