Comparative Results of the Patients with Intracerebral and Intra-sylvian Hematoma in Ruptured Middle Cerebral Artery Aneurysms

Abstract

ObjectiveTo clarify the prognosis of the patients with intra-sylvian hematoma (ISH) and intracerebral hematoma (ICH) in ruptured middle cerebral artery (MCA) aneurysms.MethodsWe categorized hematoma into ISH and ICH by the presence of intra-hematomal contrast enhancing vessel (IHCEV) on computed tomography angiography (CTA). Forty-four ruptured MCA aneurysm patients with ICH or ISH were grouped by the grading system proposed by the authors in our previous study. We investigated the relevance of the following factors: patient's age, gender, Hunt-Hess grade, Glasgow outcome scale (GOS) and changes in Glasgow coma scale (GCS) between pre-operation and 7 days after operation.ResultsThere were no significant differences statistically in age, gender, Hunt-Hess grade, and GOS between the ISH and ICH groups. In their peri-operative GCS change, the ICH group showed greater improvement compared to the ISH group (p = 0.0391). The hematoma grade had a significant relevance with the patients' GOS.ConclusionAlthough there were no significant statistic differences in the GOS of the 2 hematoma groups, there were prominent improvements of post-operative GCS in the ICH group. Unlike in the ISH group, effective removal of hematoma was possible in most patients of the ICH group. Thus although there is no difference in the prognosis of the 2 groups, early surgical evacuation of hematoma seems to be effective in improving the short-term GCS score in peri-operative period.

Ruptured Anterior Communicating Artery Aneurysms Concomitant with Small Intracranial Hematoma: Evacuating Hematoma or Not?

“… 4 , 7–11 The rate of unfavorable outcomes in our study was 44.8%, which is in accordance with the range of 21.4% to 76.2% as reported in previous studies. 1 , 2 , 5 , 7 , 10 , 14 , 16–19 The poor initial clinical conditions, age, occurrence of spontaneous infarction, symptomatic vasospasm, ICH volume, aneurysm size, and midline shift are predictors of prognosis in patients with ICH secondary to aneurysms. 1 , 5 , 7 , 18 The clot evacuation is considered an important predictor of prognosis in ruptured MCA aneurysms concomitant with ICH, especially in large hematomas.…”

“… 1 , 5 , 7 , 18 The clot evacuation is considered an important predictor of prognosis in ruptured MCA aneurysms concomitant with ICH, especially in large hematomas. 14 , 15 However, the volume of ICH secondary to ruptured AcomA aneurysms is smaller than that of MCA aneurysms, which results in lesser occupying effect. The excessive surgery on the AcomA adjacent to the crucial anatomical structures may result in damage.…”

“… 4 Composite therapy of aneurysm clipping or endovascular coiling and hemorrhage drainage has become widely accepted for ruptured MCA aneurysms concomitant with ICH. 14 , 15 However, the ICH caused by ruptured AcomA aneurysms may differ clinically from that of ICH caused by MCA aneurysms. The ICH volume secondary to ruptured AcomA aneurysms is smaller than that of MCA aneurysms, due to less subarachnoid space.…”