Treatment of ruptured anterior communicating artery aneurysm accompanying intracerebral hematomas: endovascular coiling followed by hematoma evacuation with burr hole trephination and catheterization |
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Authors: | Joonho Chung Byung Moon Kim Yong Sam Shin Yong Cheol Lim Sang Kyu Park |
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Institution: | (1) Department of Neurosurgery, Seoul St. Mary’s Hospital, Catholic University of Korea, 505, Banpo-Dong, Seocho-Gu, 442-721 Seoul, Republic of Korea;(2) Department of Radiology, Sungkunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea;(3) Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea |
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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. |
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Keywords: | Subarachnoid hemorrhage Anterior communicating artery aneurysm Intracerebral hematoma Endovascular coiling |
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