Fei Xie1, Jianqiang Hao1, Seidu A Richard2,3, Yuanli Yang4, Wuchun Zou4, Hong-Bin Liu1, Min Deng4, Changwei Zhang2. 1. Department of Neurosurgery. 2. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, P. R. China. 3. Department of Medicine, Princefield University, Ho-Volta Region, Ghana West Africa. 4. Department of Obstetrics and Gynecology, Ziyang First People's Hospital, Ziyang.
Abstract
RATIONALE: Subarachnoid hemorrhages (SAHs) from ruptured intracranial aneurysms are very rare during pregnancy. Management of ruptured intracranial aneurysms with SAH in pregnancy is often challenging because of the risks to the fetus and the mother. We present the first successful awake endovascular coiling of a dissected intracranial aneurysm in a third trimester twin pregnancy. PATIENT CONCERNS: A 28 years' old pregnant woman was admitted at the obstetric department of our hospital on account of very severe headaches associated with nausea and vomiting. DIAGNOSIS: Emergency obstetric ultrasound scan done confirmed 32 weeks' twin gestation, whereas magnetic resonance imaging established hemorrhage in the suprasellar cistern and the subarachnoid space. Magnetic resonance angiography revealed a dissected aneurysm in the ophthalmic segment of the left internal carotid artery. INTERVENTIONS: Awake cerebral angiography as well as embolization of the aneurysm with coils was done via the transarterial route and the twins were delivered via caesarean section at 37 weeks' gestation. OUTCOMES: Two years' follow-up indicated no complications and children as well as their mother are healthy. LESIONS: Awake endovascular coiling was very beneficial in our case because we avoided general anesthesia and the use of osmotic diuretics which are potentially hazardous during pregnancy.
RATIONALE: Subarachnoid hemorrhages (SAHs) from ruptured intracranial aneurysms are very rare during pregnancy. Management of ruptured intracranial aneurysms with SAH in pregnancy is often challenging because of the risks to the fetus and the mother. We present the first successful awake endovascular coiling of a dissected intracranial aneurysm in a third trimester twin pregnancy. PATIENT CONCERNS: A 28 years' old pregnant woman was admitted at the obstetric department of our hospital on account of very severe headaches associated with nausea and vomiting. DIAGNOSIS: Emergency obstetric ultrasound scan done confirmed 32 weeks' twin gestation, whereas magnetic resonance imaging established hemorrhage in the suprasellar cistern and the subarachnoid space. Magnetic resonance angiography revealed a dissected aneurysm in the ophthalmic segment of the left internal carotid artery. INTERVENTIONS: Awake cerebral angiography as well as embolization of the aneurysm with coils was done via the transarterial route and the twins were delivered via caesarean section at 37 weeks' gestation. OUTCOMES: Two years' follow-up indicated no complications and children as well as their mother are healthy. LESIONS: Awake endovascular coiling was very beneficial in our case because we avoided general anesthesia and the use of osmotic diuretics which are potentially hazardous during pregnancy.
Authors: G Mavromatidis; K Dinas; A Mamopoulos; D Delkos; C Vosnakis; K Michailidis; D Rousso Journal: J Obstet Gynaecol Date: 2011-10 Impact factor: 1.246
Authors: Daniel O Selo-Ojeme; Laurence A G Marshman; Amaju Ikomi; Dale Ojutiku; Robert A Aspoas; Sanjiv J Chawda; Gursharan P S Bawa; Manjit S Rai Journal: Eur J Obstet Gynecol Reprod Biol Date: 2004-10-15 Impact factor: 2.435