Endoscopic brainwash after clipping a ruptured aneurysm of the communicating segment of the intracranial carotid artery

Marcos Devanir Silva da Costa; Renan R. de Souza Lopes; Juan Leonardo Serrato-Avila; Sergio Cavalheiro; Feres Chaddad-Neto

doi:10.25259/SNI_680_2020

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2020

:11;

396

doi:

10.25259/SNI_680_2020

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Endoscopic brainwash after clipping a ruptured aneurysm of the communicating segment of the intracranial carotid artery

Marcos Devanir Silva da Costa¹, Renan R. de Souza Lopes¹, Juan Leonardo Serrato-Avila¹, Sergio Cavalheiro¹, Feres Chaddad-Neto^1,2

1Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Brazil.

2Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.

*Corresponding author: Juan Leonardo Serrato-Avila, Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Suão Paulo, Brazil. jls_avila@hotmail.com

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Received: 2020-09-28, Accepted: 2020-10-21, Published: 2020-11-18

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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.

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 6^th 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

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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.

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.

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www.surgicalneurologyint.com

REFERENCES

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Annotations[1-4]

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[1] d’Arcangues C, Schulz M, Bührer C, Thome U, Krause M, Thomale UW. Extended experience with neuroendoscopic lavage for posthemorrhagic hydrocephalus in neonates. World Neurosurg. 2018;116:e217-4.
[Google Scholar]

[2] Granados OS, da Costa MD, Costa BL, GonzálezEcheverría K, Paganelli SL, Caramanti RL, . Microsurgery for upper basilar tip aneurysm with intraoperative rupture: 3-dimensional operative video. Oper Neurosurg (Hagerstown). 2019;16:43.
[Google Scholar]

[3] Idris Z, Abdullah J, Raj J. Early experience in endoscopic management of massive intraventricular hemorrhage with literature review. Asian J Neurosurg. 2014;9:124-9.
[Google Scholar]

[4] Riechelmann GS, da Costa MD, Caramanti RL, Goiri MA, Costa BL, González-Echeverría K, . Microsurgical clip placement for a giant anterior communicating artery aneurysm with intraluminal thrombus: 2-Dimensional operative video. Oper Neurosurg (Hagerstown). 2019;16:E92-3.
[Google Scholar]