Abbed Khalid M, Ogilvy Christopher S
Department of Neurosurgery, Cerebrovascular Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts 02114, USA.
Neurosurg Focus. 2003 Oct 15;15(4):E4. doi: 10.3171/foc.2003.15.4.4.
Patients who present with an intraparenchymal hematoma associated with a ruptured aneurysm usually require urgent clot evacuation and aneurysm obliteration. The impact of the presence of hematoma on outcome has been poorly characterized. The authors report on 460 patients who had dense subarachnoid hemorrhage (SAH) (Fisher Grades 3 and 4) with and without associated hematoma.
Of the 959 consecutive patients who presented with SAH, 460 patients with Fisher Grade 3 and 4 SAH were analyzed and divided into two groups: those with (Group 1) and those without (Group 2) hematoma. The presenting Hunt and Hess grade and 6-month outcomes of the two groups were compared. Of the 460 patients, 116 (25%) had intraparenchymal hematomas and admission Hunt and Hess grades were worse in Group 1 compared with Group 2. Outcome scores were worse for Group 1 compared with Group 2; however, when comparing Group 1 and Group 2 within the same initial Hunt and Hess score, there was no statistical difference in outcome.
Intraparenchymal hematoma in association with SAH does not differ significantly from those patients without associated hematomas. We therefore recommend aggressive clot evacuation and aneurysm obliteration.
出现与破裂动脉瘤相关的脑实质内血肿的患者通常需要紧急清除血凝块并闭塞动脉瘤。血肿的存在对预后的影响一直未得到充分描述。作者报告了460例患有致密蛛网膜下腔出血（SAH）（Fisher分级3级和4级）且伴有或不伴有相关血肿的患者。
在959例连续出现SAH的患者中，对460例Fisher分级3级和4级SAH患者进行分析并分为两组：有血肿组（第1组）和无血肿组（第2组）。比较两组的初始Hunt和Hess分级以及6个月时的预后。在这460例患者中，116例（25%）有脑实质内血肿，第1组的入院Hunt和Hess分级比第2组差。第1组的预后评分比第2组差；然而，在相同的初始Hunt和Hess评分下比较第1组和第2组时，预后无统计学差异。
与SAH相关的脑实质内血肿与无相关血肿的患者相比无显著差异。因此，我们建议积极清除血凝块并闭塞动脉瘤。
