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Updated: May 23, 2026
18:50
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Hyperacute cerebral aneurysm rerupture during CT angiography
Fon-Yih Tsuang1, I-Chang Su, Jo-Yu Chen
1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
Journal of Neurosurgery
|March 27, 2012
Summary
Active bleeding during cerebral CT angiography in subarachnoid hemorrhage patients often leads to poor outcomes. However, early surgery can improve results for those with good initial neurological status who rapidly decline.
Area of Science:
- Neurosurgery
- Neuroradiology
- Critical Care Medicine
Background:
- Aneurysmal subarachnoid hemorrhage (SAH) is a critical neurological emergency.
- Identifying prognostic factors in SAH is crucial for patient management.
Observation:
- This study focused on a rare subgroup of SAH patients with active contrast extravasation during initial CT angiography (CTA).
- 21 cases (9 from the institute, 12 from literature review) were analyzed.
Findings:
- Active aneurysmal bleeding during CTA is associated with poor overall outcomes, with 76% of patients experiencing unfavorable results.
- Patients presenting with poor neurological status had universally fatal outcomes, irrespective of treatment.
- Patients with good initial neurological status who experienced rapid deterioration during CTA had a chance for favorable outcomes with immediate, effective decompressive surgery and aneurysm obliteration.
Implications:
- Active aneurysmal rebleeding during CTA, though uncommon, is a devastating event with high mortality.
- Timely surgical intervention (decompressive surgery and aneurysm obliteration) offers a potential survival benefit for a specific subgroup of SAH patients.
- Prompt recognition and aggressive management are critical for patients with good initial neurological status who deteriorate during CTA.
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