Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq.
College of Medicine, University of Baghdad, Baghdad, Iraq.
Neurol India. 2020 Jan-Feb;68(1):124-131. doi: 10.4103/0028-3886.279677.
The incidence of intracerebral hematoma among patients with aneurysmal subarachnoid hemorrhage is up to third of the cases (12%-35%). The presence of an aneurysm with ICH negatively influences the patient's presentation, course, and outcome, and may be associated with an increased re-hemorrhage rate, vasospasm, cerebral edema, and hydrocephalus. Aneurysm obliteration and hematoma evacuation have been associated with a favourable outcome.
To explore the effectiveness and the prognostic factors for patients with middle cerebral artery aneurysm associated with intracerebral hematoma treated by early surgical clipping of the aneurysm with hematoma evacuation.
We analysed 21 patients with intracerebral hematoma caused by ruptured middle cerebral artery aneurysm presented to the Neurosurgery teaching hospital from January 2017 to January 2019. Parameters included five broad categories: demographic, clinical, radiological, surgical, and outcome.
We found the following factors significantly related with unfavorable patient outcome: Preoperative cranial nerves deficit, dysphasia, severe contralateral weakness, presence of dilated ventricles in CT scan, presence of IVH in CT scan, aneurysm location in the dominant (left) hemisphere, high modified-Fisher grade, duration of surgery more than six hours, occurrence of intraoperative aneurysm rupture, poor postoperative GCS, occurrence postoperative vasospasm, more severe postoperative contralateral weakness, and the presence of postoperative seizure. While the good initial GCS and early surgery significantly related to favourable patient outcome.
Early surgical intervention of intracerebral hematoma caused by ruptured middle cerebral artery aneurysm has a favourable outcome in general and should be supported with consideration of the significant prognostic factors for each patient before the commencement of the surgery.
颅内出血在蛛网膜下腔出血伴发的动脉瘤患者中的发病率高达三分之一（12%-35%）。ICH 的存在会对患者的表现、病程和结局产生负面影响，并且可能与再出血率增加、血管痉挛、脑水肿和脑积水有关。动脉瘤闭塞和血肿清除与有利的结果相关。
探讨早期手术夹闭动脉瘤并清除血肿治疗大脑中动脉动脉瘤伴发脑内血肿患者的效果和预后因素。
我们分析了 2017 年 1 月至 2019 年 1 月神经外科教学医院收治的 21 例因大脑中动脉动脉瘤破裂引起的脑内血肿患者。参数包括五个广泛的类别：人口统计学、临床、影像学、手术和结局。
我们发现以下因素与患者预后不良显著相关：术前颅神经缺损、构音障碍、严重对侧无力、CT 扫描显示脑室扩张、CT 扫描显示 IVH、动脉瘤位于优势（左）半球、改良 Fisher 分级高、手术时间超过 6 小时、术中动脉瘤破裂、术后 GCS 差、术后血管痉挛、术后对侧肌力加重更严重，以及术后癫痫发作。而良好的初始 GCS 和早期手术与患者的良好预后显著相关。
一般来说，早期手术干预破裂的大脑中动脉动脉瘤引起的脑内血肿有良好的预后，并且应该在手术开始前考虑每个患者的显著预后因素。
