• S Ayuzawa, A Matsumura, and T Nose.
• Department of Neurosurgery, Moriya-Daiichi General Hospital, Ibaraki, Japan.
• Surg Neurol. 1993 Sep 1; 40 (3): 251-4.

AbstractA 42-year-old male with subarachnoid and large intracerebral hemorrhage in coma was operated without preoperative angiography because of impending cerebral herniation. After emergent decompressive craniotomy, intraoperative digital subtraction angiography (DSA) was performed and a middle cerebral artery aneurysm was demonstrated clearly. Aneurysmal neck clipping was successfully performed, and the patient made a good recovery and returned to almost independent activity with minimal hemiparesis. The prognosis of patients with ruptured aneurysm with large intracerebral hematoma is affected by early hematoma evacuation. Since the time spent for preoperative angiography may cause irreversible damage to the brain stem, in such case, early decompressive procedure and subsequent aneurysm diagnosis by intraoperative DSA may be used as alternative method to achieve a good outcome.

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