Intracerebral Hematoma and Aneurysms

Abstract

Object. The aim of this study was to evaluate the efficacy of a treatment combination of coil embolization and clot evacuation in patients presenting with an intracerebral hematoma (ICH) caused by the rupture of an aneurysm. Methods. Twenty-seven patients were prospectively recruited in this study between 1996 and 2000. Endovascular treatment of the putative ruptured aneurysm was performed as soon as practical after diagnosis and before surgical evacuation of the ICH. The Glasgow Outcome Scale (GOS) was used during follow up. Despite admission World Federation of Neurosurgical Societies grades of IV or V in 25 patients (92%), 13 (48%) recovered well with GOS scores of 1 or 2, whereas six patients (21%) died. Conclusions. The combined result of a favorable outcome in 48% of the patients and a mortality rate of 21% indicates that this treatment may be a valuable alternative for this patient group and warrants further study. I remember with nostalgia my days in 1992 and 1993 at the Radcliffe infirmary when coil placement had been just started as treatment of aneurysms. During subsequent years methods and materials have been refined and I suppose this is the reason that no adverse effects (for example, occlusion of the parent vessel) were reported in the article by Niemann, et al., during the implementation of the method. The authors mentioned that there was a small number of patients in whom aneurysm anatomy was unsuitable for coil insertion. I would like to ask them if the anatomy of the aneurysm was modified by the presence and the pressure of the surrounding hematoma. The excellent results of the paper show what can be achieved when first-rate neurosurgeons and interventional neuroradiologists cooDerate.