大脑外侧裂内血肿与大脑内血肿伴大脑中动脉破裂性动脉瘤的比较：临床意义、技术考量及预后评估
Comparison Between Intrasylvian and Intracerebral Hematoma Associated with Ruptured Middle Cerebral Artery Aneurysms: Clinical Implications, Technical Considerations, and Outcome Evaluation.
作者信息
Sturiale Carmelo Lucio, Scerrati Alba, Ricciardi Luca, Rustemi Oriela, Auricchio Anna Maria, Norri Nicolò, Piazza Amedeo, Ranieri Fabio, Benato Alberto, Tomatis Alberto, Albanese Alessio, Mangiola Annunziato, Di Egidio Vincenzo, Zotta Donato Carlo, Farneti Marco, Marchese Enrico, Raco Antonino, Volpin Lorenzo, Trevisi Gianluca
机构信息
Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Translational Medicine, University of Ferrara, Ferrara, Italy; Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy.
出版信息
World Neurosurg. 2023 May;173:e821-e829. doi: 10.1016/j.wneu.2023.03.024. Epub 2023 Mar 10.
BACKGROUND
Subarachnoid hemorrhage (SAH) due to a middle cerebral artery (MCA) aneurysm rupture is often associated with an intracerebral hematoma (ICH) or intrasylvian hematoma (ISH).
METHODS
We reviewed 163 patients with ruptured MCA aneurysms associated with pure SAH or SAH plus ICH or ISH. The patients were first dichotomized according to the presence of a hematoma (ICH or ISH). Next, we performed a subgroup analysis comparing ICH versus ISH to explore their relationship with the most relevant demographic, clinical, and angioarchitectural features.
RESULTS
Overall, 85 patients (52%) had a pure SAH, and 78 (48%) had presented with an associated ICH or ISH. No significant differences were observed in the demographics or angioarchitectural features between the 2 groups. However, the Fisher grade and Hunt-Hess score were higher for the patients with hematomas. A good outcome was observed in a higher percentage of patients with pure SAH compared with those with an associated hematoma (76% vs. 44%), although the mortality rates were comparable. Age, Hunt-Hess score, and treatment-related complications were the main outcome predictors on multivariate analysis. Patients with ICH appeared worse clinically compared with those with ISH. We also found that older age, a higher Hunt-Hess score, larger aneurysms, decompressive craniectomy, and treatment-related complications were associated with poor outcomes among the patients with an ISH, but not an ICH, which appeared, per se, as a more severe clinical condition.
CONCLUSIONS
Our study has confirmed that age, Hunt-Hess score, and treatment-related complications influence the outcome of patients with ruptured MCA aneurysms. However, in the subgroup analysis of patients with SAH associated with an ICH or ISH, only the Hunt-Hess score at onset appeared as an independent predictor of the outcome.
背景
大脑中动脉（MCA）动脉瘤破裂导致的蛛网膜下腔出血（SAH）常伴有脑内血肿（ICH）或大脑外侧裂血肿（ISH）。
方法
我们回顾了163例破裂的MCA动脉瘤患者，这些患者伴有单纯SAH或SAH加ICH或ISH。首先根据血肿（ICH或ISH）的存在将患者分为两组。接下来，我们进行了亚组分析，比较ICH与ISH，以探讨它们与最相关的人口统计学、临床和血管结构特征之间的关系。
结果
总体而言，85例患者（52%）为单纯SAH，78例（48%）伴有ICH或ISH。两组在人口统计学或血管结构特征方面未观察到显著差异。然而，有血肿的患者Fisher分级和Hunt-Hess评分更高。与伴有血肿的患者相比，单纯SAH患者的良好预后比例更高（76%对44%），尽管死亡率相当。年龄、Hunt-Hess评分和治疗相关并发症是多变量分析中的主要预后预测因素。与ISH患者相比，ICH患者的临床情况似乎更差。我们还发现，年龄较大、Hunt-Hess评分较高、动脉瘤较大、去骨瓣减压术以及治疗相关并发症与ISH患者（而非ICH患者）的不良预后相关，ICH本身似乎是一种更严重的临床情况。
结论
我们的研究证实，年龄、Hunt-Hess评分和治疗相关并发症会影响破裂MCA动脉瘤患者的预后。然而，在伴有ICH或ISH的SAH患者亚组分析中，仅发病时的Hunt-Hess评分是预后的独立预测因素。
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