Shimoda M, Oda S, Mamata Y, Tsugane R, Sato O
Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
J Neurosurg. 1997 Aug;87(2):170-5. doi: 10.3171/jns.1997.87.2.0170.
In this retrospective study, the authors analyzed surgical outcomes in patients who suffered an intracerebral hemorrhage (ICH) as a result of a ruptured middle cerebral artery aneurysm. They studied 47 patients who underwent early aneurysm surgery and hematoma evacuation within 24 hours after onset of ICH. The types of ICH were classified into three groups according to their appearance on computerized tomography scanning: 1) temporal ICH; 2) intrasylvian hematoma; and 3) ICH with diffuse subarachnoid hemorrhage (SAH). Overall, 25 patients (53%) achieved a favorable outcome and 18 (38%) died. Factors that could be used to predict a favorable outcome included age less than 60 years, temporal ICH, World Federation of Neurological Surgeons Grade II or III, absence of a surgical complication, and a hematoma volume less than 25 ml. In the patients with temporal ICH, eight of nine patients achieved a good recovery and no patient developed a surgical complication or delayed ischemic deficit. The significant prognostic factor in patients with an intrasylvian hematoma was surgery within 6 hours after onset of symptoms. In patients with temporal ICH or intrasylvian hematoma, the results of the initial neurological examination did not accurately predict outcome. On the other hand, in patients with ICH and diffuse SAH, those patients who developed an ICH with a volume greater than 25 ml had a poor prognosis. These results indicate that aggressive surgical treatment should be performed in patients with a temporal ICH or an intrasylvian hematoma, regardless of the neurological findings on admission; in patients with ICH and diffuse SAH, a careful review of surgical indications is required.
在这项回顾性研究中，作者分析了因大脑中动脉瘤破裂导致脑出血（ICH）患者的手术结果。他们研究了47例在脑出血发作后24小时内接受早期动脉瘤手术和血肿清除术的患者。根据计算机断层扫描的表现，将脑出血的类型分为三组：1）颞叶脑出血；2）大脑外侧裂血肿；3）伴有弥漫性蛛网膜下腔出血（SAH）的脑出血。总体而言，25例患者（53%）获得了良好的结果，18例（38%）死亡。可用于预测良好结果的因素包括年龄小于60岁、颞叶脑出血、世界神经外科医师联合会分级为II级或III级、无手术并发症以及血肿体积小于25 ml。在颞叶脑出血患者中，9例患者中有8例恢复良好，且无一例患者出现手术并发症或迟发性缺血性神经功能缺损。大脑外侧裂血肿患者的重要预后因素是症状发作后6小时内进行手术。在颞叶脑出血或大脑外侧裂血肿患者中，初始神经学检查结果并不能准确预测预后。另一方面，在伴有弥漫性SAH的脑出血患者中，血肿体积大于25 ml的患者预后较差。这些结果表明，对于颞叶脑出血或大脑外侧裂血肿患者，无论入院时的神经学检查结果如何，都应积极进行手术治疗；对于伴有弥漫性SAH的脑出血患者，则需要仔细评估手术指征。
