Advances in aneurysm treatment with a focus on middle cerebral artery aneurysms and delayed cerebral ischemia

In this thesis different aspects of aneurysmal subarachnoid hemorrhage (aSAH) are investigated with an emphasis on middle cerebral artery (MCA) aneurysm treatment outcome, hemorrhage volume quantification on different locations, and delayed cerebral ischemia (DCI). First, the literature is reviewed to study the clinical and imaging outcome of clipping and coiling of MCA aneurysms. Next, the association of intraparenchymal hematoma volume (≤/> 50ml) after aSAH of MCA aneurysms with clinical outcome is studied. Furthermore, a new automatic hematoma quantification method is validated in a cohort of patients with MCA aneurysms. This method is used in two studies to investigate the association of hematoma volume (total and location-specific) with the occurrence of DCI in patients with aneurysms on various locations. Lastly, the difference in the occurrence of DCI and in clinical outcome of patients with endovascularly treated aneurysms receiving either high- or low-dose nadroparin after the treatment is studied.