Ruptured middle cerebral artery aneurysm and bilateral chronic subdural hematomas

While rupture of a cerebral aneurysm into the subdural space is rare, aneurysmal subarachnoid hemorrhage in the presence of subdural hematoma(s) is much more uncommon. Such a patient requires changes in routine perioperative management.

A patient with a ruptured middle cerebral artery bifurcation aneurysm and bilateral subdural hematomas is presented. He underwent successful aneurysm clipping and subdural hematoma evacuations. At the time of surgery, measures commonly used to obtain brain relaxation were avoided. The patient was kept normovolemic, normocarbic, and normotensive. He recovered completely and resumed his prior occupation.

Changes in standard techniques for a patient undergoing a pterional craniotomy for a ruptured cerebral aneurysm are required when bilateral extra-axial mass lesions are present.