Abstract
Background:
Intracranial aneurysms are common vascular malformation occurring in 1-2% of the population and accounting for 80–85% of nontraumatic subarachnoid hemorrhages. About 10% of the ruptured aneurysm causing subarachnoid hemorrhage (SHA) develop intraventricular hemorrhage (IVH). In this scenario, the external ventricular drain (EVD) is a usual treatment for IVH. To reduce the time for the clot absorption, the neuroendoscopy with clot removal and ventricular irrigation is a feasible option, although not routinely used.
Case Description:
This 2D video shows a case of a 60-year-old female, with sudden headache associated with nausea and vomit. The brain angiotomography revealed aneurysm in the communicating segment of the left internal carotid artery, with 10.5 mm of diameter; also showed intraparenchymal, subarachnoid, and IVH, with a Fisher Modified Grade of 4 and a prompt aneurysm clipping and EVD were performed. Two days after the first surgical procedure, a neuroendoscopy was performed to remove the ventricular clots and improve the patient outcomes.
Conclusion:
In the presented case, at the 6th postoperative month, the patient was Grade 1 in the Rankin Modified Scale and without hydrocephalus. This procedure can be used routinely as an additional tool to microsurgical clipping to improve patients outcome.
Keywords: Aneurysm, Brainwash, Clipping, Neuroendoscopy
The video shows the patient’s clinical presentation, preoperative imaging studies, surgical technique step by step, and finally, clinical and imaging outcome.
Annotations[1-4]
0:23 – Clinical presentation.
0:41 – Neuroimaging findings.
3:40 – Identification of key anatomical landmarks.
4:07 – Carotid cistern opening.
4:28 – Third ventriculostomy.
5:39 – Clipping the aneurysm.
6:25 – Neuroendoscopy with ventricle full of clot.
8:01 – Fenestration of the septum pellucidum.
8:28 – Postoperative studies.
8:45 – Disease background.
Supplementary Material
Footnotes
How to cite this article: da Costa MD, de Souza Lopes RR, SerratoAvila JL, Chaddad-Neto S, Chaddad F. Endoscopic brainwash after clipping a ruptured aneurysm of the communicating segment of the intracranial carotid artery. Surg Neurol Int 2020;11:396.
Contributor Information
Marcos Devanir Silva da Costa, Email: marcoscostaneuro@gmail.com.
Renan R. de Souza Lopes, Email: rr.souzalopes@gmail.com.
Juan Leonardo Serrato-Avila, Email: jls_avila@hotmail.com.
Sergio Cavalheiro, Email: sergiocavalheironeuro@gmail.com.
Feres Chaddad-Neto, Email: fereschaddad@hotmail.com.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Video 1]-Available on:
REFERENCES
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