Intrasylvian/Intracerebral Hematomas Associated with Ruptured MCA-Aneurysms: A Single-center Series and a review of literature.

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Intrasylvian/Intracerebral Hematomas Associated with Ruptured MCA-Aneurysms: A Single-center Series and a review of literature.

World Neurosurg. 2016 Nov 12;:

Authors: Zhang Y, Hu Q, Xue H, Zhang M, Shen J, Deing L, Liu Q, Li G

Abstract
OBJECTIVE: Ruptured MCA aneurysms usually lead to SAH，and several cases will represent concomitant intrasylvian or intracerebral hematomas. The objective of this paper was to compare the clinical and radiographic characteristics with their different outcomes.
METHODS: The charts of 30 consecutive patients with ruptured MCA aneurysm related intracranial hematoma were retrospectively reviewed. These patients were dichotomized into ISH group and ICH group by the presence of intrahematomal contrast enhancing vessel (IHCEV), and for patients under open surgery, hematoma type was further confirmed by intraoperative observation. The characteristics were compared between this two groups, i.e. age, gender, history of HP, history of smoking, systolic pressure at admission, hematoma volume, size and side of aneurysms, the angle between the pointing direction of the aneurysm and the MCA trunk and is denoted as α, middle line shifting, treatment modality and outcome. All of the angles are measured in the anterior-posterior projection.
RESULTS: In our series, only hematoma volume, the angle αand the middle line shift showed statistical significance regarding prognosis among two hematoma groups. The angle αbetween 109.0°and 216.0°is associated with ISH，while aneurysm with an angle beyond this range would indicate ICH. In our series patients in the ICH group had a much larger hematoma volume compared with the ISH patient(33.3±17.6versus 11.5±10.5 p=0.002). But there exists no statistical difference regarding prognosis between these two groups, even though there is a trend towards worse recovery for patients in the ISH group(GOS 3.0±1.3versus3.8±1.9, P=0.07).
CONCLUSIONS: In our series, the prognosis of patients with ICH was much worse than those with ISH. Early discrimination of these two types of hematoma helps to predict future outcome, the angle (between the pointing direction of aneurysm and the MCA trunk) between 109.0°and 216.0° is associated with ISH, while aneurysm with an angle beyond this range might suggest ICH.

PMID: 27847269 [PubMed - as supplied by publisher]

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