Treatment of ruptured anterior communicating artery aneurysm accompanying intracerebral hematomas: endovascular coiling followed by hematoma evacuation with burr hole trephination and catheterization.
BACKGROUND
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).


CONCLUSIONS
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.
Chung
Joonho
J
Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, 505, Banpo-Dong, Seocho-Gu, 442-721 Seoul, Republic of Korea.
Kim
Byung Moon
BM
Shin
Yong Sam
YS
Lim
Yong Cheol
YC
Park
Sang Kyu
SK
D000328:Adult; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002941:Circle of Willis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011859:Radiography; D013995:Time; D016896:Treatment Outcome; D014207:Trephining / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods