Subarachnoid Hemorrhage &
Cerebral Aneurysms

Subarachnoid hemorrhage is one of the most devastating types of hemorrhage in the brain. It usually occurs due to rupture of a cerebral ‘berry’ aneurysm. The aneurysm is most accurately detected in a patient of SAH by performing a ‘DSA’ (Digital Subtraction Angiogram). The aneurysm has to be detected and occluded as fast as possible to prevent life threatening re-bleed and to allow aggressive prevention & treatment of vasospasm by using ‘HHH’ therapy. The incidence of re-bleed following SAH is 20% in the 1st 2 weeks, 50% in the next 6 months & 3-4% per year thereafter.

World over, ‘Coiling’ of the aneurysm is steadily replacing open Surgery (Clipping) as the safer & preferred modality of occluding the aneurysm ( ISAT Trial 2002 ). It can be done at any stage after the SAH, even in the presence of vasospasm. Most surgeons avoid clipping in the 1st two weeks after the SAH, to avoid worsening of vasospasm. This exposes the patient to the high risk of re-bleed in this period.

Rapid advances in the technique of coiling have brought most of the aneurysms into the category of ‘aneurysms suitable for coiling’. ‘Balloon remodeling technique’ & ‘stent assisted coiling’ have made most wide-necked aneurysms amenable to coiling. Hitherto ‘surgical’ aneurysms are also now being routinely treated by coiling. 

The following cases done by Dr. Alurkar demonstrate the efficacy of this procedure:

1) A-comm aneurysm coiled

2) Balloon assisted coiling of wide-necked Para-opthalmic ICA aneurysm

3) Coiling of large Lt. paraopthalmic ICA aneurysm

4) Balloon assisted coiling of wide-necked P-comm aneurysm

5) Coiling of Distal ACA aneurysm, traditionally considered as more suitable for clipping

6) Coiling of basilar top aneurysm

7) Coiling of MCA bifurcation aneurysm, traditionally considered as more suitable for clipping