Ventriculocisternal drainage via endoscopic third ventriculostomy after endovascular embolization for aneurysmal...

Coil embolization is a favoured method of treating acutely ruptured aneurysms. However, subarachnoid clots cannot be removed with endovascular treatment, which is disadvantageous from the view point of preventing vasospasm. The authors report intrathecal fibrinolytic therapy via a ventricular drainage tube instituted after endoscopic third ventriculostomy for effective prevention of vasospasm after coil embolization. Two cases of poor grade aneurysmal subarachnoid haemorrhage were treated with interlocking detachable coils. Following the acute stage embolization, endoscopic third ventriculostomy was performed and a drainage tube was inserted into a lateral ventricle or basal cistern. Intrathecal fibrinolytic therapy with Urokinase was performed via the drain tube to a spinal drain. In both cases, the subarachnoid clot disappeared rapidly without any clinical signs of vasospasm. Copyright 1999 Harcourt Publishers Ltd.