Summary
The clinical characteristics of patients who presented in poor clinical grade due to ruptured middle cerebral artery aneurysms (MCAAs) associated with large sylvian hematomas (SylH) were analyzed and an ingenious designed prophylactic hinged craniectomy was introduced. Twenty-eight patients were graded into Hunt-Hess grades IV–V and emergency standard micro-neurosurgeries (aneurysm clipping, hematoma evacuation and prophylactic hinged craniectomy) were performed, and their clinical data were retrospectively analyzed. 46.43% of the patients reached encouraged favorable outcomes on discharge. The favorable outcome group and the poor outcome group significantly differed in terms of patients’ anisocoria, Hunt-Hess grade before surgery, extent of the midline shift and time to the surgery after bleeding (P<0.05). There were no significant differences in age, sex, volume and location of the hematoma, size of aneurysm between the favorable and poor groups (P>0.05). However, ingenious designed prophylactic hinged craniectomy efficiently reduced the patients’ intracranial pressure (ICP) after surgery. It was suggested that preoperative conditions such as Hunt-Hess grading, extent of the midline shift and the occurrence of cerebral hernia affect the prognosis of patients, but time to the surgery after bleeding and prophylactic hinged craniectomy are of significant importance for optimizing the prognosis of MCAA patients presenting with large SylH.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rinne J, Hernesniemi J, Niskanen M, et al. Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome. Neurosurgery, 1996,38(1):2–11
Ahn JY, Han IB, Joo JY. Aneurysm in the penetrating artery of the distal middle cerebral artery presenting as intracerebral haemorrhage. Acta Neurochir (Wien), 2005,147(12):1287–1290
Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg, 1968,28(1):14–20
Broderick JP, Brott TG, Duldner JE. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke, 1993,24(7):987–993
Jennett B, Bond M. Assessment of outcome after severe brain damage: A Practical Scale. Lancet, 1975,305(7905): 480–484
Mutoh T, Ishikawa T, Moroi J. Impact of early surgical evacuation of sylvian hematoma on clinical course and outcome after subarachnoid hemorrhage. Neurol Med Chir (Tokyo), 2010,50(3):200–208
Saito A, Akamatsu Y, Mikawa S, et al. Comparison of large intrasylvian and subpial hematomas caused by rupture of middle cerebral artery aneurysm. Neurol Med Chir (Tokyo), 2010,50(4):281–285
Shimoda M, Oda S, Mamata Y, et al. Surgical indications in patients with an intracerebral hemorrhage due to ruptured middle cerebral artery aneurysm. J Neurosurg, 1997,87(2): 170–175
Abbed KM, Ogilvy CS. Intracerebral hematoma from aneurysm rupture. Neurosurg Focus, 2003,15(4):E4
Tokuda Y, Inagawa T, Katoh Y, et al. Intracerebral hematoma in patients with ruptured cerebral aneurysms. Surg Neurol, 1995,43(3):272–277
Britz GW. ISAT trial: coiling or clipping for intracranial aneurysms? Lancet, 2005,366(9488):783–785
Başkaya MK, Menendez JA, Yüceer N, et al. Results of surgical treatment of intrasylvian hematomas due to ruptured intracranial aneurysms. Clin Neurol Neurosurg, 2001,103(1):23–28
Prat R, Galeano I. Early surgical treatment of middle cerebral artery aneurysms associated with intracerebral haematoma. Clin Neurol Neurosurg, 2007,109(5): 431–435
Güresir E, Schuss P, Vatter H, et al. Decompressive craniectomy in subarachnoid hemorrhage. Neurosurg Focus, 2009,26(6):E4
Smith ER, Carter BS, Ogilvy CS. Proposed use of prophylactic decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage patients presenting with associated large sylvian hematomas. Neurosurgery, 2002,51(1):117–124
Otani N, Takasato Y, Masaoka H, et al. Surgical outcome following decompressive craniectomy for poor-grade aneurysmal subarachnoid hemorrhage in patients with associated massive intracerebral or Sylvian hematomas. Cerebrovasc Dis, 2008,26(6):612–617
Kenning TJ, Gandhi RH, German JW. A comparison of hinge craniotomy and decompressive craniectomy for the treatment of malignant intracranial hypertension: early clinical and radiographic analysis. Neurosurg Focus, 2009,26(6):E6
Yoshimoto Y, Wakai S, Satoh A, et al. Intraparenchymal and intrasylvian haematomas secondary to ruptured middle cerebral artery aneurysms: prognostic factors and therapeutic considerations. Br J Neurosurg, 1999,13(1):18–24
Author information
Authors and Affiliations
Corresponding authors
Additional information
This project was supported by National Natural Science Foundation of China (No. 81201026).
Rights and permissions
About this article
Cite this article
Wang, Hj., Ye, Yf., Shen, Y. et al. Surgical treatment of poor grade middle cerebral artery aneurysms associated with large sylvian hematomas following prophylactic hinged craniectomy. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 34, 716–721 (2014). https://doi.org/10.1007/s11596-014-1341-x
Received:
Revised:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11596-014-1341-x