TY - JOUR
T1 - Comparison Between Intrasylvian and Intracerebral Hematoma Associated with Ruptured Middle Cerebral Artery Aneurysms: Clinical Implications, Technical Considerations, and Outcome Evaluation
AU - Sturiale, C. L.
AU - Scerrati, A.
AU - Ricciardi, L.
AU - Rustemi, O.
AU - Auricchio, A. M.
AU - Norri, N.
AU - Piazza, A.
AU - Ranieri, F.
AU - Benato, A.
AU - Tomatis, A.
AU - Albanese, Alessio
AU - Mangiola, A.
AU - Di, Egidio V.
AU - Zotta, D. C.
AU - Farneti, M.
AU - Marchese, Enrico
AU - Raco, A.
AU - Volpin, L.
AU - Trevisi, G.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Hematoma
KW - ICH
KW - Intracerebral
KW - Intrasylvian
KW - Middle cerebral artery
KW - SAH
KW - Subarachnoid hemorrhage
KW - Hematoma
KW - ICH
KW - Intracerebral
KW - Intrasylvian
KW - Middle cerebral artery
KW - SAH
KW - Subarachnoid hemorrhage
UR - https://publicatt.unicatt.it/handle/10807/262884
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=85151242222&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85151242222&origin=inward
U2 - 10.1016/j.wneu.2023.03.024
DO - 10.1016/j.wneu.2023.03.024
M3 - Article
SN - 1878-8750
VL - 173
SP - 1
EP - 9
JO - World Neurosurgery
JF - World Neurosurgery
IS - N/A
ER -