Acta Neurochirurgica

, Volume 159, Issue 3, pp 543–547 | Cite as

Middle cerebral artery aneurysms with intracerebral hematoma—the impact of side and volume on final outcome

  • Ondrej Navratil
  • Kamil Duris
  • Vilem Juran
  • Eduard Neuman
  • Karel Svoboda
  • Martin Smrcka
Clinical Article - Vascular
  • 223 Downloads

Abstract

Background

Middle cerebral artery aneurysms (MCA aneurysms) belong to the most frequent type of intracranial aneurysms forming an intracerebral hematoma. The consequences of the hematoma—the laterality, the impact of ICH volume and size of the aneurysm with the final outcome of these patients had not been studied in detail in this location, and we focused on the analysis of these factors.

Methods

Patients with MCA aneurysms and associated intracerebral hematomas with a volume ≥10 ml were studied; these were treated from January 2006 to December 2015. During this period, more than 700 patients with spontaneous subarachnoid hemorrhage were admitted to the Department of Neurosurgery, University Hospital Brno. The data were collected from the subarachnoid hemorrhage database of the unit and from the local hospital registry. All consecutive patients at the treating center were involved in this retrospective study. We collected clinical data such as age, gender, aneurysm location, preoperative hematoma size, Hunt-Hess grade and type of surgical procedures. We focused on the analysis of the final outcome [Glasgow Outcome Scale (GOS) score] in relation to ICH volume, side of bleeding and finally the relationship between aneurysm size and the volume of ICH.

Results

Fifty-eight patients with an MCA aneurysm and ICH were included; the mean age of this series was 59.4 years. Thirty-six patients (62%) had clinical status Hunt-Hess 4–5 on admission. The mean size of the intracerebral hematoma was 47.1 ml (10–133 ml). Most frequently, in 30 patients (52%), the hematoma had bled into the temporal lobe. Fifty three patients were operated on, and 5 were treated conservatively because of their poor condition. Twenty-three patients (40%) had a favorable Glasgow Outcome Scale score, and 35 (60%) had an unfavorable outcome including 20 patients (35%) who died. Of the 53 patients operated on, 20 (38%) underwent decompressive hemicraniectomy (DHC). Patients with an unfavorable outcome had significantly larger hematomas with a median size of 54 ml, whereas those with a favorable outcome had a median size of 26 ml (p = 0.0022). Larger hematomas were found on the right side. The cutoff volume for an unfavorable outcome in ICH was 25 ml. The outcomes were not related to the side of the ICH (p = 0.42), and the aneurysm size did not predetermine the ICH volume (p = 0.3159).

Conclusion

Our study confirms the benefit of the active treatment of patients with MCA aneurysms and associated ICH. A significant proportion of these patients achieves a favorable outcome. No association between the side of bleeding and outcome was demonstrated. Hematomas larger than 25 ml have a greater tendency to lead to an unfavorable outcome. The treatment decision-making process should not differ for either side.

Keywords

Intracranial aneurysm Middle cerebral artery Intracerebral hematoma Outcome 

References

  1. 1.
    Abbed KM, Ogilvy CS (2003) Intracerebral hematoma from aneurysm rupture. Neurosurg Focus 15:E4CrossRefPubMedGoogle Scholar
  2. 2.
    Baskaya MK, Menendez JA, Yuceer N, Polin RS, Nanda A (2001) Results of surgical treatment of intrasylvian hematomas due to ruptured intracranial aneurysms. Clin Neurol Neurosurg 103:23–28CrossRefPubMedGoogle Scholar
  3. 3.
    Choi IS, David C (2003) Giant intracranial aneurysms: development, clinical presentation and treatment. Eur J Radiol 46:178–194CrossRefPubMedGoogle Scholar
  4. 4.
    Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737CrossRefPubMedGoogle Scholar
  5. 5.
    Hernesniemi J, Vapalahti M, Niskanen M, Tapaninaho A, Kari A, Luukkonen M, Puranen M, Saari T, Rajpar M (1993) One-year outcome in early aneurysm surgery: a 14 years experience. Acta Neurochir (Wien) 122:1–10CrossRefGoogle Scholar
  6. 6.
    Inagawa T, Hirano A (1990) Ruptured intracranial aneurysms: an autopsy study of 133 patients. Surg Neurol 33:117–123CrossRefPubMedGoogle Scholar
  7. 7.
    Jabbarli R, Reinhard M, Roelz R, Shah M, Niesen WD, Kaier K, Taschner C, Weyerbrock A, Van Velthoven V (2016) Intracerebral hematoma due to aneurysm rupture: are there risk factors beyond aneurysm location? Neurosurgery 78:813–820CrossRefPubMedGoogle Scholar
  8. 8.
    Liu X, Rinkel GJ (2011) Aneurysmal and clinical characteristics as risk factors for intracerebral haematoma from aneurysmal rupture. J Neurol 258:862–865CrossRefPubMedGoogle Scholar
  9. 9.
    Ljunggren B, Saveland H, Brandt L, Zygmunt S (1985) Early operation and overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 62:547–551CrossRefPubMedGoogle Scholar
  10. 10.
    Mutoh T, Ishikawa T, Moroi J, Suzuki A, Yasui N (2010) Impact of early surgical evacuation of sylvian hematoma on clinical course and outcome after subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 50:200–208CrossRefGoogle Scholar
  11. 11.
    Natarajan SK, Sekhar LN, Ghodke B, Britz GW, Bhagawati D, Temkin N (2008) Outcomes of ruptured intracranial aneurysms treated by microsurgical clipping and endovascular coiling in a high-volume center. AJNR Am J Neuroradiol 29:753–759CrossRefPubMedGoogle Scholar
  12. 12.
    Papo I, Bodosi M, Doczi T (1987) Intracerebral haematomas from aneurysm rupture: their clinical significance. Acta Neurochir (Wien) 89:100–105CrossRefGoogle Scholar
  13. 13.
    Pasqualin A, Bazzan A, Cavazzani P, Scienza R, Licata C, Da Pian R (1986) Intracranial hematomas following aneurysmal rupture: experience with 309 cases. Surg Neurol 25:6–17CrossRefPubMedGoogle Scholar
  14. 14.
    Prat R, Galeano I (2007) Early surgical treatment of middle cerebral artery aneurysms associated with intracerebral haematoma. Clin Neurol Neurosurg 109:431–435CrossRefPubMedGoogle Scholar
  15. 15.
    Rinne J, Hernesniemi J, Niskanen M, Vapalahti M (1996) Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome. Neurosurgery 38:2–11CrossRefPubMedGoogle Scholar
  16. 16.
    Rosen DS, Macdonald RL, Huo D, Goldenberg FD, Novakovic RL, Frank JI, Rosengart AJ (2007) Intraventricular hemorrhage from ruptured aneurysm: clinical characteristics, complications, and outcomes in a large, prospective, multicenter study population. J Neurosurg 107:261–265CrossRefPubMedGoogle Scholar
  17. 17.
    Salary M, Quigley MR, Wilberger JE Jr (2007) Relation among aneurysm size, amount of subarachnoid blood, and clinical outcome. J Neurosurg 107:13–17CrossRefPubMedGoogle Scholar
  18. 18.
    Shimoda M, Oda S, Mamata Y, Tsugane R, Sato O (1997) Surgical indications in patients with an intracerebral hemorrhage due to ruptured middle cerebral artery aneurysm. J Neurosurg 87:170–175CrossRefPubMedGoogle Scholar
  19. 19.
    Tapaninaho A, Hernesniemi J, Vapalahti M (1988) Emergency treatment of cerebral aneurysms with large haematomas. Acta Neurochir (Wien) 91:21–24CrossRefGoogle Scholar
  20. 20.
    Tokuda Y, Inagawa T, Katoh Y, Kumano K, Ohbayashi N, Yoshioka H (1995) Intracerebral hematoma in patients with ruptured cerebral aneurysms. Surg Neurol 43:272–277CrossRefPubMedGoogle Scholar
  21. 21.
    Vermeulen M, van Gijn J, Hijdra A, van Crevel H (1984) Causes of acute deterioration in patients with a ruptured intracranial aneurysm. A prospective study with serial CT scanning. J Neurosurg 60:935–939CrossRefPubMedGoogle Scholar
  22. 22.
    Weir B, Findlay JM (1994) Subarachnoid hemorrhage, in Neurovascular Surgery. McGraw-Hill, Inc, New York, pp 557–581Google Scholar
  23. 23.
    Yasargil MG (1984) Microneurosurgery, Volume 2. Georg Thieme Verlag, Stuttgart, pp 124–164Google Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Hospital BrnoBrnoCzech Republic

Personalised recommendations