Treatment Strategy for Severe Subarachnoid Hemorrhage in an Older Adult Patient Complicated by Casting Intraventricular Hematoma

Abstract

  Favorable outcomes have recently been reported regarding coil embolization for acute cerebral aneurysms, even in cases of severe subarachnoid hemorrhage in older adults. Several reports have demonstrated that neuroendoscopic hematoma evacuation is better than ventricular drainage alone in patients with massive intraventricular hemorrhaging. In the present older adult patient with a casting intraventricular hematoma, we performed a combined treatment of cerebral aneurysm coil embolization and neuroendoscopic hematoma evacuation for acute severe subarachnoid hemorrhage, which has a particularly poor prognosis. Aggressive treatment is often avoided in older adult patients due to the risks posed by surgical invasiveness and disease severity. There are only a few reports of surgery for managing similar cases, and those reports identified the safety of the surgical procedures as an area of concern.