Surgical management of aneurysmal hematomas in the presence of brain herniation on arrival: a single-center case series analysis.

Surgical management of aneurysmal hematomas in the presence of brain herniation on arrival: a single-center case series analysis.

World Neurosurg. 2018 Mar 12;:

Authors: Wang MQ, Zhao X, Wang XF, Han C, Xing DG, Wang CW

Abstract
BACKGROUND: The purpose of this study was to assess the outcomes in aggressively treated patients with aneurysmal intracerebral hematoma (ICH) and signs of brain herniation, and to investigate possible predictive factors.
METHODS: This retrospective study included 43 patients with aneurysmal ICH who presented with brain herniation at emergency department (ED) admission and received aggressive surgical treatment between 2008 and 2016. Emergency surgical clipping, removal of hematoma, and external decompression were combined as an aggressive surgical treatment. Outcomes were assessed using in-hospital survival and the Glasgow Outcome Scale (GOS) at a 6- month follow-up.
RESULTS: All the patients were World Federation of Neurological Surgeons (WFNS) grade V on presentation. The mean hematoma volume was 59.1±16.5 mL. The in-hospital mortality rate was 48.8%. At the 6- month follow-up, favorable outcomes were achieved in 7 patients (16.3%). Significant factors related to death included bilateral mydriasis, lower initial Glasgow Coma Scale (GCS) scores, larger hematoma volume, and no pupil reactivity recovery after surgery. Bilateral restoration of pupil reactivity and higher initial GCS scores were associated with 6- month favorable outcomes. Patients who had intrasylvian hematomas were more likely to achieve a favorable outcome than patients who had intraparenchymal hematomas (62.5% vs. 5.7%; P=0.001).
CONCLUSIONS: The data indicated that the protocol of aggressive surgical treatment in patients with herniated aneurysmal ICHs might be warranted. Despite mydriasis, favorable outcomes might be achieved in a certain number of patients. However, careful individual patient -centered decision making is essential, particularly when bilateral pupil dilation persists.

PMID: 29545220 [PubMed - as supplied by publisher]

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