Document Detail


Posterior fossa decompression and clot evacuation for fourth ventricle hemorrhage after aneurysmal rupture: case report.
MedLine Citation:
PMID:  11440445     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE AND IMPORTANCE: Massive intraventricular hemorrhage due to aneurysmal rupture is associated with a dismal prognosis. An intraventricular clot causing fourth ventricle dilation can cause compression to the brainstem similar to other posterior fossa masses such as cerebellar hemorrhage or infarction. The presence of fourth ventricle dilation carries a very high risk of death within 48 hours. Neither ventricular drainage nor fibrinolytic infusion has been successful in eliminating clots of the fourth ventricle. Posterior fossa decompression and direct evacuation of the clot could have good results in relieving brainstem compression caused by the clot. CLINICAL PRESENTATION: A 45-year-old woman was admitted to our intensive care unit after experiencing an aneurysmal subarachnoid hemorrhage. The neurological examination at admission revealed that she was in Grade V according to the World Federation of Neurological Surgeons grading system, but brainstem reflexes were present. Computed tomographic scanning revealed a massive intraventricular hemorrhage, with fourth ventricle dilation caused by an intraventricular clot. Bilateral external ventricular drains were placed to relieve elevated intracranial pressure. Cerebral angiography revealed a 1-cm basilar tip aneurysm, which was embolized with Guglielmi detachable coils (Boston Scientific, Boston, MA) during the same procedure. INTERVENTION: Given the patient's poor neurological condition, it was decided that brainstem compression should be relieved. A posterior fossa decompressive craniectomy was performed immediately after coil therapy, with direct evacuation of the intraventricular clot. The patient experienced a clear improvement in the level of consciousness and has achieved a good neurological result at early follow-up. CONCLUSION: Dilation of the fourth ventricle by an intraventricular clot is a sign of brainstem compression that can be relieved by posterior fossa decompression and direct clot evacuation.
Authors:
A Lagares; C M Putman; C S Ogilvy
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  49     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-07-06     Completed Date:  2001-11-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  208-11     Citation Subset:  IM    
Affiliation:
Neurosurgical Service, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
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MeSH Terms
Descriptor/Qualifier:
Aneurysm, Ruptured / complications
Cerebral Angiography
Cerebral Hemorrhage / etiology,  radiography,  surgery*
Cranial Fossa, Posterior / surgery*
Decompression, Surgical*
Female
Fourth Ventricle*
Hematoma / etiology,  radiography,  surgery*
Humans
Intracranial Aneurysm / complications
Middle Aged
Tomography, X-Ray Computed
Comments/Corrections
Comment In:
Neurosurgery. 2002 May;50(5):1166-7; author reply 1167   [PMID:  11987277 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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