Recovery After Aneurysm Rupture and Coiling Surgery

Ruptured cerebral aneurysm, subarachnoid hemorrhage, has undergone embolization surgery?

Hello Doctor, thank you very much for taking the time to respond.

On Day 0, my father experienced a sudden severe headache on the morning of December 2nd.
He was taken to the hospital half an hour later.
At that time, he had weakness in his legs but was still able to answer the nurses' questions.
After a CT scan, it was confirmed that he had a ruptured anterior communicating artery aneurysm.
Following the examination, he fell into a coma and was intubated.
Due to the hospital's inability to perform the necessary procedures, he was transferred to a medical center, where a drainage surgery was performed 3-4 hours after the headache, followed by an aneurysm embolization procedure.
On Day 1, the drainage was ineffective, and thrombolytic therapy was initiated.
On Day 2, an evaluation was conducted for minimally invasive surgery to remove blood clots from both the left and right hemispheres of the brain.
Post-surgery, intracranial pressure decreased to below 20.
Sedatives were administered postoperatively, and for the next two weeks, there were no signs of fever or hydrocephalus.
On Day 7, sedative medications were discontinued, leaving only pain relief medications.
He remained in a coma but began to occasionally open one eye and move his hands.
On Day 12, acupuncture treatment was initiated.
On Day 16, a tracheostomy was performed, and respiratory training began.
By Day 18, external drainage had not shown any new cerebrospinal fluid accumulation for two days, leading to an assessment for the removal of all drainage tubes.
On Day 19, he was transferred to a respiratory care unit for enhanced respiratory training.
He remained in a coma but became more responsive to sounds, frequently opening both eyes, and showed increased movement in his hands.
Currently, on Day 20, it is being evaluated whether he can be weaned off the ventilator and transferred to a general ward.
In the past few days, I have researched literature and papers that mention hyperbaric oxygen therapy and transcranial magnetic stimulation as beneficial for postoperative recovery.
However, in the literature regarding hyperbaric oxygen, I only found one study suggesting that it is most suitable to start one week after ischemic events, and three to four weeks after hemorrhagic events.
I sincerely apologize for bothering you, but since I may not encounter the attending physician when I return on the sixth day, I would like to ask you:
1.
Based on past experiences, what is the most appropriate timing to introduce hyperbaric oxygen therapy after a ruptured cerebral aneurysm has been treated with embolization?
2.
Additionally, I would like to inquire whether a tracheostomy is typically removed after the patient is awake, or can it be removed once they are able to breathe independently?
3.
I understand that predicting awakening is quite difficult, but I would really like to know what common signs of awakening are.
I truly apologize for the inconvenience, as I have fewer opportunities to meet with the attending physician.
Thank you very much for your response.

Jeff, 30~39 year old female. Ask Date: 2023/12/22

Dr. Zhang Junwei reply Neurosurgery

1.
Hyperbaric oxygen therapy does not have a specific intervention time; it can begin once the condition is stable.
2.
After regaining consciousness, a physician can reassess the situation.
3.
It's really difficult to say.

Reply Date: 2023/12/22

More Info

Recovery after an aneurysm rupture and subsequent coiling surgery is a complex process that varies significantly from patient to patient. Your father's case, involving a ruptured anterior communicating artery aneurysm, highlights several critical aspects of post-operative care and recovery.

1. Timing for Hyperbaric Oxygen Therapy (HBOT): The literature on the use of hyperbaric oxygen therapy following a subarachnoid hemorrhage (SAH) or aneurysm rupture is still evolving. Generally, HBOT is considered beneficial for promoting healing and reducing the risk of secondary brain injury due to hypoxia. For ischemic strokes, it is often recommended to start HBOT within a week. However, for hemorrhagic strokes, including those from aneurysm ruptures, the consensus suggests waiting at least 3 to 4 weeks post-event. This delay allows for stabilization of the patient's condition and minimizes the risk of exacerbating any existing bleeding or complications. Therefore, in your father's case, it would be prudent to discuss with his medical team the potential for initiating HBOT around the 3 to 4-week mark post-surgery, provided he is stable and there are no contraindications.

2. Tracheostomy Removal: The timing for tracheostomy removal typically depends on the patient's ability to breathe independently and their overall neurological status. In many cases, tracheostomy tubes are removed when the patient can maintain adequate oxygenation and ventilation without assistance. This often occurs after the patient has regained consciousness and demonstrated the ability to follow commands or respond to stimuli. In your father's situation, since he is showing signs of responsiveness, the medical team will assess his respiratory function closely. If he can breathe adequately on his own and is alert enough, the tracheostomy can be removed.

3. Signs of Awakening: The process of regaining consciousness after a significant brain injury can be unpredictable. However, there are common signs that may indicate a patient is beginning to awaken. These include:
- Increased eye-opening, especially in response to stimuli.

- Following simple commands or moving in response to verbal cues.

- Improved motor responses, such as moving limbs or squeezing hands.

- Increased alertness and responsiveness to the environment, such as turning the head towards voices or sounds.

- Changes in vital signs, such as improved heart rate and blood pressure stability.

It's essential to maintain open communication with the medical team, as they can provide the most accurate assessments based on your father's specific condition. They will monitor his neurological status closely and adjust treatment plans as necessary.

In summary, recovery from an aneurysm rupture and coiling surgery involves careful monitoring and individualized care. The timing for interventions like hyperbaric oxygen therapy should be discussed with the healthcare team, and tracheostomy removal will depend on your father's respiratory independence. Signs of awakening can vary, but increased responsiveness is a positive indicator. Your proactive approach in seeking information and understanding the recovery process is commendable, and I wish your father a smooth and successful recovery.

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