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http://dx.doi.org/10.3340/jkns.2014.55.5.273

Endovascular Treatment of a Ruptured Posterior Inferior Cerebellar Artery Aneurysm during Pregnancy  

Kim, Ki Dae (Department of Neurosurgery, Yeungnam University Medical Center and Medical School)
Chang, Chul Hoon (Department of Neurosurgery, Yeungnam University Medical Center and Medical School)
Choi, Byung Yon (Department of Neurosurgery, Yeungnam University Medical Center and Medical School)
Jung, Young Jin (Department of Neurosurgery, Yeungnam University Medical Center and Medical School)
Publication Information
Journal of Korean Neurosurgical Society / v.55, no.5, 2014 , pp. 273-276 More about this Journal
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is quite rare, however it has a high maternal mortality rate. A pregnant woman in the 16th gestational week was admitted to our hospital with a drowsy level of consciousness. A brain magnetic resonance (MR) image showed hemorrhage on the prepontine cistern, and both sylvian fissures, and MR angiography and cerebral digital subtraction angiography demonstrated an aneurysm at the left posterior inferior cerebellar artery (PICA). We performed endovascular coil embolization attempting to minimize radiation exposure. She was discharged with no neurologic deficit and delivered a healthy baby by cesarean section at the 38th week of gestation. This case study reported the shortest gestational period and this is the first report on an aneurysmal rupture arising from PICA which was treated using an endovascular method. Using an appropriate technique for reduced radiation exposure to the fetus and limited alterations in maternal-fetal physiology, endovascular coil embolization could guarantee good results in treatment of aneurysmal SAH in pregnant women.
Keywords
Embolization; Posterior inferior cerebellar artery; Pregnancy; Radiation; Subarachnoid hemorrhage;
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1 Botterell EH, Cannell DE : Subarachnoid hemorrhage and pregnancy. Am J Obstet Gynecol 72 : 844-855, 1956   DOI
2 Daane TA, Tandy RW : Rupture of congenital intracranial aneurysm in pregnancy. Obstet Gynecol 15 : 305-314, 1960
3 Dias MS, Sekhar LN : Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. Neurosurgery 27 : 855-865; discussion 865-866, 1990   DOI
4 Giannotta SL, Daniels J, Golde SH, Zelman V, Bayat A : Ruptured intracranial aneurysms during pregnancy. A report of four cases. J Reprod Med 31 : 139-147, 1986
5 International Commission on Radiological Protection : Pregnancy and medical radiation. Ann ICRP 30 : iii-viii, 1-43, 2000   DOI
6 Kizilkilic O, Albayram S, Adaletli I, Kantarci F, Uzma O, Islak C, et al. : Endovascular treatment of ruptured intracranial aneurysms during pregnancy : report of three cases. Arch Gynecol Obstet 268 : 325-328, 2003   DOI
7 Kuon E, Schmitt M, Dahm JB : Significant reduction of radiation exposure to operator and staff during cardiac interventions by analysis of radiation leakage and improved lead shielding. Am J Cardiol 89 : 44-49, 2002   DOI
8 Mas JL, Lamy C : Stroke in pregnancy and the puerperium. J Neurol 245 : 305-313, 1998   DOI   ScienceOn
9 Meyers PM, Halbach VV, Malek AM, Phatouros CC, Dowd CF, Lawton MT, et al. : Endovascular treatment of cerebral artery aneurysms during pregnancy : report of three cases. AJNR Am J Neuroradiol 21 : 1306-1311, 2000
10 Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. : International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366 : 809-817, 2005   DOI   ScienceOn
11 Mosiewicz A, Jakiel G, Janusz W, Markiewicz P : [Treatment of intracranial aneurysms during pregnancy]. Ginekol Pol 72 : 86-92, 2001
12 Muir S, McLeod R, Dove R : Light-weight lead aprons--light on weight, protection or labelling accuracy? Australas Phys Eng Sci Med 28 : 128-130, 2005   DOI
13 Ogilvy CS, Quinones-Hinojosa A : Surgical treatment of vertebral and posterior inferior cerebellar artery aneurysms. Neurosurg Clin N Am 9 : 851-860, 1998
14 Peluso JP, van Rooij WJ, Sluzewski M, Beute GN, Majoie CB : Posterior inferior cerebellar artery aneurysms: incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol 29 : 86-90, 2008   DOI   ScienceOn
15 Piotin M, de Souza Filho CB, Kothimbakam R, Moret J : Endovascular treatment of acutely ruptured intracranial aneurysms in pregnancy. Am J Obstet Gynecol 185 : 1261-1262, 2001   DOI
16 Pool JL : Treatment of intracranial aneurysms during pregnancy. JAMA 192 : 209-214, 1965   DOI
17 Pumar JM, Pardo MI, Carreira JM, Castillo J, Blanco M, Garcia-Allut A : Endovascular treatment of an acutely ruptured intracranial aneurysm in pregnancy : report of eight cases. Emerg Radiol 17 : 205-207, 2010   DOI
18 Riviello C, Ammannati F, Bordi L, Lamassa M, Mennonna P, Parretti E, et al. : Pregnancy and subarachnoid hemorrhage: a case report. J Matern Fetal Neonatal Med 16 : 245-246, 2004   DOI
19 Schwartz J : Pregnancy complicated by subarachnoid hemorrhage. Am J Obstet Gynecol 62 : 539-547, 1951   DOI
20 Stoodley MA, Macdonald RL, Weir BK : Pregnancy and intracranial aneurysms. Neurosurg Clin N Am 9 : 549-556, 1998
21 Youmans JR, Winn HR : Youmans Neurological Surgery, ed 6. Philadelphia : Saunders/Elsevier, 2011
22 Tarnaris A, Haliasos N, Watkins LD : Endovascular treatment of ruptured intracranial aneurysms during pregnancy: is this the best way forward? Case report and review of the literature. Clin Neurol Neurosurg 114 : 703-706, 2012   DOI