Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, P. R. China.
Department of Medicine, Princefield University, Ho-Volta Region, West Africa.
Medicine (Baltimore). 2022 Sep 9;101(36):e30129. doi: 10.1097/MD.0000000000030129.
Intracerebral hematoma (ICH) as a result of ruptured of intracranial aneurysms often arises in patients with subarachnoid hemorrhage. Few studies focused on risk factors for ICH and not the impact of residual hematoma after evacuation on the outcomes of the patients. Therefore, 2 questions need to be answered: does residual hematoma after evacuation have impact on the outcome of patients who present with ICH as a result of ruptured intracranial aneurysms? Is radical pursuit of the hematoma necessary? The study was a single-center longitudinal observational type. Data of 2044 consecutive patients with subarachnoid hemorrhage from January 2009 to December 2019 were reviewed. ICHs were established and the locations of aneurysms as well as hematoma volumes were measured by computed tomographic scan before aneurysm occlusion. Only patients who received aneurysm clipping were included. Patients were stratified into hematoma evacuation without residuals versus residual hematoma after evaluation groups, and outcome was assessed according to the modified Rankin Scale (mRS) at 6 months. Out of the 1365 patients who received clipping, 476 patients presented in poor grade, whereas 889 patients' good grade. Our mRS scores revealed that patients who attained hematoma evacuation without residuals in the good-grade category attained better functional outcome than those with residual hematoma after evacuation. Contrarily, our mRS scores did not establish any significant difference in outcome between the poor-grade patients with hematoma evacuation without residuals and patients with residual hematoma after evacuation. Furthermore, our logistic regression model showed that advance age, poor Hunt-Hess grade, and vascular injury due to surgery were contributing factors for poor outcome of patients with ICH. Our data suggested that aggressive hematoma evacuation may not benefit the poor-grade patients. Majority of poor outcomes were due to surgical complications which were vascular related as a result of excessive pursuit of ICH.
颅内血肿（ICH）是蛛网膜下腔出血患者颅内动脉瘤破裂的结果，ICH 通常发生在蛛网膜下腔出血患者中。很少有研究关注 ICH 的危险因素，也没有研究残留血肿对患者预后的影响。因此，需要回答以下两个问题：血肿清除术后残留血肿对破裂颅内动脉瘤所致 ICH 患者的预后有影响吗？是否有必要彻底清除血肿？这项研究是一项单中心的纵向观察性研究。回顾了 2009 年 1 月至 2019 年 12 月期间连续 2044 例蛛网膜下腔出血患者的数据。在血管内夹闭动脉瘤之前，通过计算机断层扫描（CT）扫描确定 ICH 的位置和动脉瘤的位置以及血肿量。仅纳入接受动脉瘤夹闭的患者。患者分为血肿清除无残留组和评估后有残留血肿组，根据改良 Rankin 量表（mRS）在 6 个月时评估预后。在接受夹闭术的 1365 例患者中，476 例患者病情较差，889 例患者病情较好。我们的 mRS 评分显示，在良好预后患者中，血肿清除无残留的患者功能预后优于血肿清除后有残留的患者。相反，我们的 mRS 评分并未在血肿清除无残留和血肿清除后有残留的较差预后患者之间建立任何显著的预后差异。此外，我们的逻辑回归模型表明，年龄较大、Hunt-Hess 分级较差和手术引起的血管损伤是 ICH 患者预后不良的危险因素。我们的数据表明，积极清除血肿可能对较差预后的患者无益。大多数不良预后是由于手术并发症所致，这些并发症是由于过度追求清除 ICH 而导致的血管相关并发症。
