M B Horowitz1, D Crammond, J Balzer, C Jungreis, A B Kassam. 1. Department of Neurosurgery, University of Pittsburgh Medical Center, Suite B400, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA. horowitz@neuronet.pitt.edu
Abstract
OBJECTIVE AND IMPORTANCE: 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. CLINICAL PRESENTATION: 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. INTERVENTION: 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. CONCLUSION: 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.
OBJECTIVE AND IMPORTANCE: 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. CLINICAL PRESENTATION: 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. INTERVENTION: 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. CONCLUSION: 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.
Authors: Tumul Chowdhury; Andrea Petropolis; Marshall Wilkinson; Bernhard Schaller; Nora Sandu; Ronald B Cappellani Journal: Anesthesiol Res Pract Date: 2014-03-03