Stereotactic aspiration of enlarged intracerebral hematoma caused by intraprocedural perforation of aneurysm during coil embolization.
BACKGROUND
Instead of surgical intervention, endovascular treatment with GDC has become an important tool to treat intracranial aneurysm in recent years. However, intraoperative aneurysm rupture remains a devastating complication for physicians. Rapid and precise packing with coils and external ventricular drainage are advised. Stereotactic aspiration of an enlarged intracerebral hematoma caused by intraprocedural perforation of aneurysm has been rarely discussed as a method of dealing with this consequence.


METHODS
The authors describe a case of a 45-year-old man who presented with sudden onset of headache. A ruptured aneurysm of approximately 5.5 mm, arising from the proximal segment of superior sylvian M2 branch on the right middle cerebral artery, was diagnosed via intracranial angiography. During transarterial embolization, perforation of the aneurysm dome by coil and microcatheter was noted. Although the aneurysm was secured by rapid coiling, progressive weakness of left extremities related to enlarged intracranial hematoma was noted. The neurologic deficits improved successfully after stereotactic aspiration of hematoma.


CONCLUSIONS
The role of stereotactic aspiration in the management of an enlarged hematoma due to intraprocedural perforation of aneurysm during coil embolization may have further implications, and it may be considered as an alternative treatment to open clot evacuation for intracranial hemorrhages with aneurysms.
Hsieh
Cheng-Ta
CT
Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, Republic of China.
Wu
Chung-Che
CC
Chiang
Yung-Hsiao
YH
Chang
Cheng-Fu
CF
D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013238:Stereotaxic Techniques; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013396:Suction