Coil Embolization and Endoscopic Hematoma Removal for Ruptured Cerebral Aneurysm With Intracranial Hematoma Under Local Sedation: A Case Report.

Autor:	Sase T; Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama Seibu Hospital, Yokohama, JPN., Nakamura H; Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama Seibu Hospital, Yokohama, JPN., Nakayama H; Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama Seibu Hospital, Yokohama, JPN., Hidaka G; Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama Seibu Hospital, Yokohama, JPN., Wakatsuki K; Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama Seibu Hospital, Yokohama, JPN.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Nov 14; Vol. 16 (11), pp. e73663. Date of Electronic Publication: 2024 Nov 14 (Print Publication: 2024).
DOI:	10.7759/cureus.73663
Abstrakt:	Intracerebral hematomas (ICHs) can complicate ruptured cerebral aneurysms. The standard approach for these cases has traditionally involved craniotomy with clipping and hematoma evacuation. Recently, however, a combination of coil embolization and neuroendoscopic hematoma removal has shown promise. We report a case of a ruptured internal carotid artery aneurysm with ICH successfully treated using coil embolization and neuroendoscopic hematoma removal under intravenous sedation. A woman in her late 70s presented to our hospital with severe consciousness disturbance and was diagnosed with subarachnoid hemorrhage (SAH) and an intratemporal hematoma caused by a ruptured aneurysm at the left internal carotid-posterior communicating artery bifurcation. Her condition was complicated by low cardiac output and hypotension due to Takotsubo cardiomyopathy, making general anesthesia unfeasible. Coil embolization was performed the same day under local sedation with dexmedetomidine hydrochloride. The next day, we used a neuroendoscope to evacuate the intratemporal hematoma under local anesthesia. Despite the severity of the SAH, the patient survived and was later transferred to a long-term care hospital. This approach appears effective for patients with ruptured cerebral aneurysms and ICH who are not suitable candidates for general anesthesia. Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Sase et al.)
Databáze:	MEDLINE
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