Basal ganglion hematoma evacuation and clipping of middle cerebral artery aneurysm by neuroendoscopy: A case report

RATIONALE: Basal ganglia hematomas resulting from the rupture of aneurysms of the distal middle cerebral artery (MCA) are extremely rare and are usually treated by craniotomy. To date, only 5 cases of MCA aneurysm have been treated using neuroendoscopy, and none of these cases involved hematomas. For the first time, we report a special case in which neuroendoscopy was used to evacuate a hematoma and clip an aneurysm at the same time. PATIENT CONCERNS: A massive basal ganglia hematoma in a 60-year-old man was evacuated using neuroendoscopy, and a distal MCA aneurysm was discovered and clipped successfully under the neuroendoscopy during the operation. DIAGNOSIS: Basal ganglia hematoma, Distal MCA aneurysm. OUTCOMES: The patient's left pupil shrunk, and his state of consciousness gradually improved after the operation. LESSONS: Our experience with this patient demonstrates that an aneurysm originating in the distal MCA and accompanied by hematoma may be treated using minimally invasive neuroendoscopy. The fact that cerebral angiography was not performed before or after this patient's first operation indicates that all basal-ganglia hematoma patients, including those with lower risks of cerebrovascular anomalies, should undergo cerebral angiography before and after surgical treatment.