Stereotactic aspiration of enlarged intracerebral hematoma caused by intraprocedural perforation of aneurysm during coil embolization

Chronic encapsulated intracerebral hematoma (CE-ICH) is an uncommon pathology that presents with headache, seizure, focal neurological deficits, or as a tumor. Trauma as a cause for CE-ICH is even rare and we believe this is the first case report as “trauma causing chronic encapsulated intracerebral hematoma “search in PubMed did not reveal any results. Repeated micro-hemorrhages in the CM or AVM are supposed to cause this lesion which progress from an earlier encapsulated phase to a thick capsulated stage with edema and clinical symptoms. CT or MRI is the diagnostic modality and it mimics, tumor, AVM, CM, angiomableed, cerebral abscess, metastatic mass or neurocysticercosis. Burr hole, mini-craniotomy, craniotomy, CT guided stereotactic aspiration or endoscopic excision are some options with equally good results. The present case with history of trauma was managed successfully with craniotomy with no recurrence for past one year. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, page: 46-48

Download Full-text

Clinical Outcomes of Coil Embolization for Acutely Ruptured Aneurysm

Interventional Neuroradiology ◽

10.1177/15910199040100s210 ◽

2004 ◽

Vol 10 (2_suppl) ◽

pp. 49-53 ◽

Cited By ~ 2

Author(s):

M. Hirohata ◽

T. Abe ◽

N. Fujimura ◽

Y. Takeuchi ◽

H. Morimitsu ◽

...

Keyword(s):

Coil Embolization ◽

Surgical Complication ◽

Cerebral Aneurysms ◽

Clinical Results ◽

Primary Treatment ◽

Additional Treatment ◽

Intracerebral Hematoma ◽

Complication Rates ◽

Symptomatic Vasospasm ◽

Primary Treatment Modality

The purpose of this prospective study was to evaluate clinical results in patients with acutely ruptured cerebral aneurysm treated by neck clipping (NC) or coil embolization (CE) when CE was considered the first option. Between 1998 and 2003, 280 patients with acutely ruptured cerebral aneurysms excluding intracerebral hematoma were evaluated. Patients were managed prospectively according to the following protocol: primary treatment modality was CE (n =179). NC (n=101) was selected for the patients with aneurysms that were small (less than 2 mm) or an unsuitable shape for CE. Surgical complication rates were 4.5% for CE and 16.8% for NC. Symptomatic vasospasm occurred in 8.4% of CE patients and 29% of NC patients. Good recovery on the Glasgow Outcome Scale was achieved by 71% of CE patients and 50% of NC patients at discharge. Surgical complications and symptomatic vasospasm were significantly reduced in CE compared to NC. Clinical outcome at discharge was also better with CE. Although 18.3% of CE patients showed various degrees of aneurysmal recanalization and 7% of CE patients required additional treatment (re-CE or NC), aneurysmal rebleeding occurred in only one patient during follow-up (mean, 3.95 years).

Download Full-text

Results of Stereotactic Aspiration in 175 Cases of Putaminal Hemorrhage

Neurosurgery ◽

10.1227/00006123-198906000-00005 ◽

1989 ◽

Vol 24 (6) ◽

pp. 814-819 ◽

Cited By ~ 63

Author(s):

Hiroshi Niizuma ◽

Yukihiko Shimizu ◽

Tsutomu Yonemitsu ◽

Nobukazu Nakasato ◽

Jiro Suzuki

Keyword(s):

Intracerebral Hematoma ◽

Entire Series ◽

Stereotactic Aspiration ◽

Computed Tomographic ◽

Consciousness Level ◽

Therapeutic Results ◽

Putaminal Hemorrhage ◽

Minimal Invasion ◽

The Brain ◽

Definite Role

Abstract Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown. These results seem to indicate that stereotactic aspiration can play a definite role in the treatment of spontaneous intracerebral hematoma.

Download Full-text

Novel Device and Technique for Minimally Invasive Intracerebral Hematoma Evacuation in the Same Setting of a Ruptured Intracranial Aneurysm

Operative Neurosurgery ◽

10.1227/neu.0000000000000650 ◽

2015 ◽

Vol 11 (1) ◽

pp. 43-51 ◽

Cited By ~ 1

Author(s):

Raymond D Turner ◽

Jan Vargas ◽

Aquilla S Turk ◽

M Imran Chaudry ◽

Alejandro M Spiotta

Keyword(s):

Minimally Invasive ◽

Operating Room ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Intracerebral Hematoma ◽

Hematoma Evacuation ◽

Angiography Suite ◽

Ruptured Intracranial Aneurysm ◽

Ruptured Intracranial Aneurysms ◽

Clot Evacuation

Abstract BACKGROUND The presence of intracerebral hematoma from aneurysm rupture is an indication for craniotomy for clot evacuation and aneurysm clipping. Some centers have begun securing aneurysms with coil embolization followed by clot evacuation in the operating room. This approach requires transporting a patient from the angiography suite to the operating room, which can take valuable time and resources. OBJECTIVE To report our experience with 3 cases in which a novel technique for minimally invasive evacuation of intracerebral hematomas after endovascular treatment of ruptured intracranial aneurysms was used. The Penumbra Apollo system can be used in the angiography suite in conjunction with neuroendovascular techniques to simultaneously address a symptomatic hematoma associated with a ruptured aneurysm. METHODS Standard preoperative computed tomography angiography was performed on arrival to the emergency department. The patients underwent diagnostic cerebral angiography followed by balloon-assisted coil embolization and then remained in the neurointerventional suite for intracerebral hematoma evacuation with the Apollo system. RESULTS All patients tolerated coil embolization and hematoma evacuation well. The combined procedures lasted <3 hours in both cases. Two patients were eventually discharged to acute rehabilitation facilities less than a month after their initial insult, and 1 has been cleared to return to work. The other patient was transferred to hospice care. CONCLUSION The Apollo aspiration system appears to be a safe and effective minimally invasive option for intracerebral hematoma evacuation, particularly when coupled with endovascular embolization of ruptured intracranial aneurysms. Future work will address which patient population is most likely to benefit from this promising technique.

Download Full-text