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Guglielmi detachable coil: report of intraoperative complications
R Gorji1, P H Willoughby, C Cozza
1Department of Anesthesia, State University of New York, Upstate Medical University, Syracuse 13210, USA.
Insights
The Guglielmi detachable coil (GDC) procedure for cerebral aneurysms can cause intraoperative hemorrhage. Early ventriculostomy placement may improve patient outcomes during this complex neurovascular intervention.
Area of Science:
- Neurosurgery
- Neuroanesthesiology
- Interventional Neuroradiology
Background:
- The Guglielmi detachable coil (GDC) is a novel endovascular treatment for cerebral aneurysms.
- Intraoperative complications, such as subarachnoid hemorrhage, can occur during GDC procedures.
- Effective anesthetic management is crucial for patient safety during these interventions.
Observation:
- This report details the anesthetic management of two patients experiencing intraoperative subarachnoid hemorrhage during GDC placement.
- The study highlights various treatment strategies for intraoperative hemorrhage.
- Other potential complications associated with intravascular intracranial coil placement are also reviewed.
Findings:
- The placement of a ventriculostomy was identified as a key factor in achieving favorable outcomes in both cases.
- Prompt management of intraoperative hemorrhage is essential for successful GDC procedures.
- The study underscores the importance of preparedness for potential complications.
Implications:
- Neuroanesthesiologists must be prepared for the unique challenges posed by GDC procedures.
- Prophylactic placement of a ventriculostomy prior to GDC intervention should be strongly considered.
- While promising, the GDC procedure necessitates careful consideration of its associated risks and complications.
Abstract:
The newest therapy for cerebral aneurysm is the Guglielmi detachable coil (GDC). The authors describe the anesthetic management of two patients with intraoperative subarachnoid hemorrhage during Guglielmi coil placement. Various treatments for intraoperative hemorrhage are discussed, as are other common complications that can occur during placement of intravascular, intracranial coils. The placement of a ventriculostomy was a major contributing factor in the good outcome of both patients. Consideration should be given to placement of a ventriculostomy before the GDC procedure. Although the GDC procedure offers much promise, it is not a benign procedure and has its own set of complications that will no doubt challenge the neuroanesthesiologist.