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Updated: Mar 2, 2026
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
[An acute subdural hematoma caused by rupture of a middle cerebral artery aneurysm]
R S Dzhindzhikhadze1, O N Dreval'2, V A Lazarev2
1Russian Medical Academy of Postgraduate Education, Moscow, Russia; Inozemtsev City Clinical Hospital, Moscow, Russia.
Abstract:
Acute subdural hematoma caused by cerebral aneurysm rupture is rare. We describe a clinical case of an acute subdural hematoma developed due to rupture of an aneurysm at the M1 segment bifurcation of the middle cerebral artery (MCA). The acute subdural hematoma associated with intracranial hypertension and transtentorial herniation resulted in a comatose condition. The patient underwent decompressive craniectomy, hematoma removal, and clipping of the aneurysm. A significant improvement was observed in the postoperative period. The patient was discharged with mild hemiparesis and moderate paresis of the oculomotor nerve. This case demonstrates the need for an urgent surgical intervention in the form of decompressive craniectomy and aneurysm clipping as life-saving surgery, even in patients with transtentorial herniation syndrome in a serious condition.
Insights
Ruptured middle cerebral artery aneurysms can cause acute subdural hematomas. Urgent surgery, including decompressive craniectomy and aneurysm clipping, is vital for survival, even in severe cases with brain herniation.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Neurology
Background:
- Acute subdural hematoma (ASH) is rarely caused by cerebral aneurysm rupture.
- Aneurysms at the middle cerebral artery (MCA) bifurcation are common sites for rupture.
Observation:
- A patient presented with acute subdural hematoma due to a ruptured MCA aneurysm at the M1 segment bifurcation.
- The patient exhibited signs of increased intracranial pressure and transtentorial herniation, leading to a comatose state.
Findings:
- Surgical intervention included decompressive craniectomy, hematoma evacuation, and aneurysm clipping.
- Postoperative recovery showed significant improvement, with the patient discharged with residual mild hemiparesis and oculomotor nerve palsy.
Implications:
- This case underscores the critical need for prompt surgical management in patients with ruptured aneurysms presenting as ASH with brain herniation.
- Decompressive craniectomy and aneurysm clipping can be life-saving interventions, even in critically ill patients.
