Aneurysm rupture during endovascular coiling: effects on cerebral transit time and neurophysiologic monitoring and the benefits of early ventriculostomy: case report.
OBJECTIVE
We report a case of intra-operative aneurysm rupture during endovascular therapy and document the effects of rupture on cerebral transit times and neurophysiologic monitoring. The effects of early ventriculostomy are clearly documented.


METHODS
A 42-year-old man with Hunt and Hess grade 1, Fisher grade 3 subarachnoid hemorrhage secondary to a 5 mm anterior communicating artery aneurysm underwent coil embolization.


METHODS
Endovascular therapy was complicated by intraprocedural aneurysm rupture. Changes in cerebral transit time and electroencephalography along with somatosensory evoked potentials were documented as were improvement in these parameters following aneurysm obliteration and ventriculostomy placement. The patient awoke without deficit and was discharged 2 weeks later with a grossly normal examination.


CONCLUSIONS
Early recognition of aneurysm rupture during coil embolization and prompt aneurysm obliteration and reduction in intracranial hypertension can lead to acceptable patient outcomes. Use of neurophysiologic monitoring in the intubated patient can help the neurosurgeon determine the need for cerebrospinal fluid drainage in such situations.
Horowitz
M B
MB
Department of Neurosurgery, University of Pittsburgh Medical Center, Suite B400, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA. horowitz@neuronet.pitt.edu
Crammond
D
D
Balzer
J
J
Jungreis
C
C
Kassam
A B
AB
D000328:Adult; D017542:Aneurysm, Ruptured / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D017130:Angioplasty / Q000009:adverse effects; D001783:Blood Flow Velocity / Q000502:physiology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006801:Humans; D002532:Intracranial Aneurysm / Q000503:physiopathology / Q000601:surgery; D008297:Male; D016343:Monitoring, Intraoperative; D013997:Time Factors; D014696:Ventriculostomy