Ruptured middle cerebral artery aneurysm and bilateral chronic subdural hematomas

BACKGROUND While rupture of a cerebral aneurysm into the subdural space is rare, aneurysmal subarachnoid hemorrhage in the presence of subdural hemato ma(s) is much more uncommon. Such a patient requires changes in routine per ioperative management. CASE DESCRIPTION A patient with a ruptured middle cerebral artery bifurcati on aneurysm and bilateral subdural hematomas is presented. He underwent suc cessful aneurysm clipping and subdural hematoma evacuations. At the time of surgery, measures commonly used to obtain brain relaxation were avoided. T he patient was kept normovolemic, normocarbic, and normotensive. He recover ed completely and resumed his prior occupation. CONCLUSIONS Changes in standard techniques for a patient undergoing a pteri onal craniotomy for a ruptured cerebral aneurysm are required when bilatera l extra-axial mass lesions are present. (C) 2001 by Elsevier Science Inc.