Introduction: Acute subdural hemorrhage (aSDH) in association with aneurismal subarachnoid hemorrhage (SAH) is a severe disease with an incidence of 0.5% to 7.9% of all SAH. Due to the rarity of aneurysmal aSDH, it remains difficult to define a comprehensive management protocol. In this case review, following the CARE guidelines, we show the hybrid management of this pathology to know the importance of using different types of neurosurgical treatments in case of two severe diseases in critical patients.
We present two patients who developed sudden onset cephalea and neurological impairment secondary to aneurysmal subarachnoid hemorrhage associated with acute subdural hematoma. These cases required emergency decompressive craniectomy and aneurysm embolization with coils that have a favorable outcome.
In patients with massive and rapidly fatal subdural hemorrhage, emergency craniotomy with hematoma evacuation and immediate brain decompression before definitive aneurysm surgery has shown to be a good treatment option with excellent survival outcomes.
Conclusion: Endovascular obliteration following a surgical procedure for evacuation of aSDH remains a reliable option to avoid any additional procedures that could result in an increased risk of morbidity in a critically ill patient with aneurysmal aSDH and SAH.
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Santellan, José Omar Resident; Aguilar, José Ramón Dr.; Ibarra, Abraham Dr.; and García, Ulises Dr.
"Aneurysmal subarachnoid hemorrhage and acute subdural hematoma, neurosurgical and endovascular rescue. Case report.,"
Archives of Neurosurgery: Vol. 1:
2, Article 3.
Available at: https://www.ansjournal.org/home/vol1/iss2/3