{"id":"6f7dadd1-23ce-440c-82ea-d59f0f978371","slug":"endoscopic-brainwash-after-clipping-a-ruptured-aneurysm-of-the-communicating-segment-of-the-intracranial-carotid-artery","title":"Endoscopic brainwash after clipping a ruptured aneurysm of the communicating segment of the intracranial carotid artery","authors":["Marcos Devanir Silva da Costa","Renan R. de Souza Lopes","Juan Leonardo Serrato-Avila","Sergio Cavalheiro","Feres Chaddad-Neto"],"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. 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. The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. www.surgicalneurologyint.com","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/neuroendoscopy.png","publishDate":"2020-11-18T00:00:00.000Z","doi":"10.25259/SNI_680_2020","categories":["Neuroendoscopy","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/6f7dadd1-23ce-440c-82ea-d59f0f978371/pdf"}