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Combined endovascular and surgical treatment in a ruptured distal anterior cerebral artery aneursym
EANS Academy. Coban M. 09/25/19; 275685; EP01131
Mustafa Kemal Coban
Mustafa Kemal Coban

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Abstract
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Distal Anterior Cerebral Artery Aneurysms ( DACA) are consist %1.5 -5 of all aneursyms . Here we present a case of ruptured DACA aneurisym , with ICH and low GCS score which is treated by a combined endovascular and surgical approach.
Case: A 45 year old man referred to our clinic because of ICH and IVH , from another hospital.
On the admission his GCS was 5 and intubated. His labaratory findings were normal except INR value of 4.8 .. Regarding his high INR values, a surgical intervention postponed and a DSA study was performed. This study revealed a 9 mm aneursym at right A2-A3 bifurcation and coil embolization of the aneursym had been carried out at the same session. After the embolization , and at an INR value of 2;surgical intervention was performed and ICH had been evacuated via a right frontal craniotomy, and an EVD had been placed . Control CT scans did not reveal any sign of hydrocephalus or cerebral infarction and EVD had been removed on 5th day The recovered gradualy and discharged with GOS 5 on 20th day.
Discussion: Aneurysmal hemorrhages tend to be more severe under anticogulant therapy. Despite our patient's unclear medical history he claims that he had been used some informal medication due to headache. Additively . The planning of treatment is more complicated in these cases. The timing of surgery , and modality to be used must be revealed more precisely. In our case the gradation of procedures eliminated the most of the potential complications.
Conclusion: Cerebral vascular pathologies may be more challenging than usual and then algorithms must be rerevealed . This can be managed by a vascular team who may perform endovascular and surgical vascular procedures in a co-ordinated manner, and in optimally leaded by a hybride neurosurgeon.
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