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Updated: Aug 8, 2026
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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
[Endovascular surgery for untreated ruptured aneurysm with symptomatic vasospasm]
A Morizane1, I Nakahara, N Sakai
1Department of Neurosurgery, National Cardio-Vascular Center, Suita-shi, Japan.
No Shinkei Geka. Neurological Surgery
|October 27, 1999
Summary
Endovascular surgery, including coil embolization and angioplasty, offers an effective treatment for ruptured aneurysms with vasospasm. Careful technique is crucial, especially in severe cases, to avoid complications and improve patient outcomes.
Area of Science:
- Neurosurgery
- Interventional Radiology
Background:
- Ruptured aneurysms with symptomatic vasospasm present significant treatment challenges.
- Direct surgery has poor outcomes, while conservative management risks rerupture and infarction.
Observation:
- Two cases of ruptured aneurysms with vasospasm were treated with coil embolization (GDC) and angioplasty (PTA) with papaverine.
- Rerupture was avoided, and PTA showed angiographic efficacy in both cases.
Findings:
- Case 1 achieved a good outcome.
- Case 2, with severe initial vasospasm, experienced cerebral infarction, indicating poor prognosis in advanced cases.
- Endovascular approaches may be challenging due to severe vasospasm, necessitating careful PTA to prevent rerupture.
Implications:
- Intra-arterial papaverine infusion is a safer alternative for distal vessel spasm but may be transient.
- Packing the rupture point while leaving the aneurysm neck unpacked can be a strategy in complex cases.
- Endovascular surgery is a viable option for managing ruptured aneurysms complicated by symptomatic vasospasm, potentially followed by direct surgery after recovery.
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