title: Emerging sylvian subpial hematoma after the repair of the ruptured anterior cerebral artery aneurysm with interhemispheric approach: case report.
abstract: A 60-year-old woman was admitted to the hospital due to a sudden loss of consciousness. Computed tomography (CT) revealed a thick subarachnoid hemorrhage in almost all of the parachiasmatic cisterns, including the sylvian cisterns, with mild hydrocephalus. Three dimensional (3D)-CT angiography showed an irregularly shaped aneurysm at the bifurcation of the left A2 and the frontopolar artery. The aneurysm was successfully obliterated by clipping through the interhemispheric approach. CT performed immediately after the operation showed a newly formed left temporal subpial hematoma. The patient's neurological status improved gradually after surgery, but deteriorated again 2 days after the operation. CT revealed an enlarging right sylviansubpial hematoma. The subpial hematoma was rapidly removed surgically. Slight hemiparesis and impaired higher cognitive function remained after a shunt procedure for subsequent hydrocephalus. Emerging sylvian hematoma associated with a distant site of a ruptured aneurysm is extremely rare. However, adequate attention is required in cases with a thick subarachnoid hemorrhage in distant fissures.
authors.affiliation: Department of Neurosurgery, NTT Medical Center Tokyo Stroke Unit, NTT Medical Center.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Minami
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kimura
authors.forename: Yasumitsu
authors.initials: Y
authors.lastname: Ichikawa
authors.forename: Akio
authors.initials: A
authors.lastname: Morita
mesh_terms: D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D002535:Cerebral Aqueduct; D003337:Corpus Callosum / Q000601:surgery; D005260:Female; D006408:Hematoma, Subdural / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed