Coil Embolization and Endoscopic Hematoma Removal for Ruptured Cerebral Aneurysm With Intracranial Hematoma Under Local Sedation: A Case Report

Intracerebral hematomas (ICHs) can complicate ruptured cerebral aneurysms. The standard approach for these cases has traditionally involved craniotomy with clipping and hematoma evacuation. Recently, however, a combination of coil embolization and neuroendoscopic hematoma removal has shown promise. We report a case of a ruptured internal carotid artery aneurysm with ICH successfully treated using coil embolization and neuroendoscopic hematoma removal under intravenous sedation. A woman in her late 70s presented to our hospital with severe consciousness disturbance and was diagnosed with subarachnoid hemorrhage (SAH) and an intratemporal hematoma caused by a ruptured aneurysm at the left internal carotid-posterior communicating artery bifurcation. Her condition was complicated by low cardiac output and hypotension due to Takotsubo cardiomyopathy, making general anesthesia unfeasible. Coil embolization was performed the same day under local sedation with dexmedetomidine hydrochloride. The next day, we used a neuroendoscope to evacuate the intratemporal hematoma under local anesthesia. Despite the severity of the SAH, the patient survived and was later transferred to a long-term care hospital. This approach appears effective for patients with ruptured cerebral aneurysms and ICH who are not suitable candidates for general anesthesia.