Hemorrhagic Cerebrovascular Diseases
Early surgical treatments of intracranial ruptured aneurysms combined with intracranial hematomas
Mingli Liang, Haiyong He, Feng Qin, Min Ye, Wenbo Zhang, Jinxing Huang, Ying Guo
Published 2015-06-15
Cite as Chin J Neuromed, 2015, 14(6): 572-575. DOI: 10.3760/cma.j.issn.1671-8925.2015.06.007
Abstract
ObjectiveTo investigate the microsurgical managements of intracranial ruptured aneurysms combined with intracranial hematomas and to observe their therapeutic efficacy.
MethodsA total of 32 patients with intracranial ruptured aneurysms combined with intracranial hematomas, treated in our hospital from January 2009 to January 2013, were chosen in our study; 18 male and 14 female patients ranged from 32 to 78 years old (mean age of 55 years) were enrolled, with sudden headache, vomiting, disturbance of consciousness as the first symptoms. The preoperative status on admission was Hunt-Hess grade III in 7, grade IV in 20 and grade V in 5. Radiographic imaging demonstrated 7 anterior communicating artery aneurysms, 3 posterior communicating artery aneurysms, 7 internal carotid artery aneurysms, 13 middle cerebral artery aneurysms and 2 multiple aneurysms. The associated hematoma was greater than 20 mL. All patients were brought emergently to the operating room and treated with aneurysm clipping within 72 h. Decompressive craniectomy was performed in 19 patients, and external ventricular drainage was performed in 19 patients.
ResultsPostoperative follow up (ranged from 3-24 months) showed good recovery, moderate recovery, severe disability, persistent vegetative state and death in 6, 12, 11, 0 and 2, respectively, graded by Glasgow Outcome Scale; the remaining one patient was lost to follow-up. The percentage of good prognosis in patients with preoperative Hunt-Hess grade of III grade (84.6%) was higher than that of patients with IV-V grade (36.8%, P<0.05).
ConclusionsEarly evacuation of space-occupying hematoma, aneurysm clipping and emergent decompessive cranioctomy could lead to survival with good recovery in some patients.
Key words:
Intracranial aneurysm; Hematoma; Microsurgical operation
Contributor Information
Mingli Liang
Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
Haiyong He
Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
Feng Qin
Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
Min Ye
Wenbo Zhang
Jinxing Huang
Ying Guo
Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China