Single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for subarachnoid hemorrhage with multiple cerebral aneurysms using Sugita head holding system: A case report
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan.
DOI:10.25259/SNI_73_2020Copyright: © 2020 Surgical Neurology International 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: Masahito Katsuki, Naomichi Wada, Yasunaga Yamamoto. Single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for subarachnoid hemorrhage with multiple cerebral aneurysms using Sugita head holding system: A case report. 25-Apr-2020;11:76
How to cite this URL: Masahito Katsuki, Naomichi Wada, Yasunaga Yamamoto. Single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for subarachnoid hemorrhage with multiple cerebral aneurysms using Sugita head holding system: A case report. 25-Apr-2020;11:76. Available from: https://surgicalneurologyint.com/surgicalint-articles/9977/
Background: Subarachnoid hemorrhage with multiple aneurysms is very challenging because it is difficult to identify the ruptured aneurysm. We could not identify the ruptured aneurysm preoperatively, so we decided to treat all of the aneurysms as a single-stage surgery.
Case Description: A 79-year-old woman was diagnosed with subarachnoid hemorrhage with multiple cerebral aneurysms at the right distal anterior cerebral artery, left middle cerebral artery, and right internal carotid artery- posterior communicating artery bifurcation. We could not identify the ruptured aneurysm preoperatively. We fixed her head using the Sugita head holding system (Mizuho Co., Ltd., Tokyo) and performed clipping for each aneurysm with bifrontal craniotomy and bilateral frontotemporal craniotomy as a single-stage operation. The last aneurysm seemed ruptured, and clipping for all the aneurysms was successful. She was discharged with a good postoperative course. The Sugita head holding system allowed turning the head of the patient toward the right and left with single fixation, leading to this single-stage operation.
Conclusion: Several methods for identifying a ruptured aneurysm from multiple aneurysms have been reported, but under limited medical resources, this procedure would be one of the treatment strategies.
Keywords: Craniotomy, Multiple aneurysms, Single-stage operation, Subarachnoid hemorrhage, Sugita head holding system
Subarachnoid hemorrhage (SAH) with multiple aneurysms is very challenging because it is difficult to identify the ruptured aneurysm. We herein report a case who underwent single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for SAH with multiple cerebral aneurysms using the Sugita head holding system[
A 79-year-old woman presented after a sudden headache. Head computed tomography (CT) diagnosed SAH [
Head computed tomography diagnosed diffuse subarachnoid hemorrhage (a and b). Computed tomography angiography revealed multiple cerebral aneurysms at the right distal anterior cerebral artery (rt. DACA) of 2.4 mm in diameter (red circle in c), left middle cerebral artery (lt. MCA) of 2.3 mm (green circle in c), and right internal carotid artery-posterior communicating artery bifurcation (rt. IC-PC) of 2.1 mm (circle in d). Intraoperative findings of the rt. DACA aneurysm (e) and the lt. MCA aneurysm (f), which seemed unruptured either. Intraoperatively, the IC-PC aneurysm had fibrin cap (arrow in g) and seemed as ruptured (g). After clipping these aneurysms, we closed the cranium with metal plates, and these procedures were performed as a single-stage operation (h). Schematic illustration of the Sugita head holding system (Mizuho Co., Ltd., Tokyo). It allowed turning the head of the patient toward the right and left with single fixation and performing this single-stage operation (i).
After the introduction of general anesthesia, we fixed her head using the Sugita head holding system (Mizuho Co., Ltd., Tokyo).[
The incidence of multiple aneurysms was 17.7–33.5%,[
Naturally, our single-stage surgery is invasive. The increased manipulation of cerebral arteries and brain tissue during multiple aneurysm surgery results in poorer outcomes than in a single aneurysm.[
Several methods for identifying the ruptured aneurysm from multiple aneurysms have been reported. However, under limited medical resources, our procedure would be one of the treatment strategies for SAH with multiple aneurysms.
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