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BRAIN ANEURYSM COILING Dr.Saurabh Joshi, MD, FNVIR www.VeinCenter.in

Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai

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Brain Aneurysm is a ballooning of the artery in the brain. This was traditionally treated by open surgery. Endovascular Coiling is the new accepted method for treatment of aneurysms. This is a safer treatment with a faster recovery period. All done through a small needle prick in the thigh. A true advancement of modern medicine

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Page 1: Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai

BRAIN ANEURYSM COILINGDr.Saurabh Joshi, MD, FNVIR

www.VeinCenter.in

Page 2: Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai

• 26 yr old male presented with sudden onset severe headache.

Page 3: Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai
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CLINICAL GRADING SCALES FOR SAH Grade Description

Hunt and Hess Scale

1 Asymptomatic or minimal headache and slight nuchal rigidity

2 Moderate to severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy

3 Drowsiness, confusion, or mild focal deficit

4 Stupor, moderate to severe hemiparesis, possible early decerebrate rigidity and vegetative disturbances

5 Deep coma, decerebrate rigidity, moribund appearance

Page 5: Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai

CLINICAL GRADING SCALES FOR SAH

Grade Description

World Federation of Neurological Surgeons Scale

1 GCS 15, no motor deficit

2 GCS 13 to 14, no motor deficit

3 GCS 13 to 14, with motor deficit

4 GCS 7 to 12, with or without motor deficit

5 GCS 3 to 6, with or without motor deficit

Page 6: Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai

THE FISHER GRADING OF SAH AS DEMONSTRATED BY CT SCAN

Grade1

2

3

4

Description

No blood detected

A diffuse deposition or thin layer with all vertical layers of blood (interhemispheric fissure, insular cistern, ambient cistern) less than 1 mm thick)

Localized clots and/or vertical layers of blood 1 mm or greater in thickness

Diffuse or no subarachnoid blood, but with intracerebral or intraventricular clots

Page 7: Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai

• Next investigation ??

Page 8: Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai

• MRA / CTA / DSA ?

•  CT angiography and MR angiography have limited sensitivity in the detection of small aneurysms.

• The accepted reference standard for identification of intracranial aneurysms is intra arterial digital subtraction angiography

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• Elective ventilation for 12 hrs.

• Extubated coming morning / HHH protocol.

• Uneventful recovery

• F/u CT after 3 days significant resolution of the SAH.

• Discharged Day 8 after coiling.

Page 16: Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai

• Dr.Saurabh Joshi is a Neuro and Vascular Interventional Radiologist practicing in a tertiary care hospital in Mumbai.

• For Appointments : +919967368256 ( Mon – Sat 9 :00 to 19:00 India Standard Time )

[email protected]