D.V. Svistov, I.N. Kachanov, B.P. Fadeev, D.V. Kandyba
(Chair of Neurosurgery, Medicomilitary Academy Minicipal Mutifield Hospital N 2, Saint Petersburg)
Patient G., aged 36, had three spontaneous subarachnoid hemorrhages in June-July 2001. Diagnostic examination, carried out in the Mariinskaya Hospital and Emergency Care Hospital N 2, was indicative of aneurysm of the superior cerebellar artery. The patient was operated in Municipal Multifield Hospital N 2 on July 17, 2001 (the forth day after the last hemorrhage). According to the WFNS classification, a state severity at the moment of operation was equal to III. Angiography demonstrated critical constrictive-stenotic arteriopathy (CSA) of the basilar artery. Chemoangioplasty with papaverine (320 mg) was followed by total embolization of aneurysm of the superior cerebellar artery by detachable microspirals (D.V. Svistov, assistant professor). A postoperative period was characterized by manifestations of progradient CSA, complicated by delayed neurologic deficit. Complete regression of focal symptoms was watched in 6 months after operation.
Control angiography (December 2001) showed aneurysm occlusion. CT examination was indicative of compensated internal hydrocephalus, a liquor cyst of the left cerebellar hemisphere, being the result of infarction in a region of the superior cerebellar artery.
The demonstration purpose was to present information on the patient with decompensated CSA and a favorable outcome of radical intravascular treatment of difficult-of-access aneurysm in an acute period of recurred hemorrhage.