Skip to main content

Advertisement

SpringerLink
Log in

Middle cerebral artery aneurysms with intracerebral hematoma—the impact of side and volume on final outcome

  • Clinical Article - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Middle cerebral artery aneurysms (MCA aneurysms) belong to the most frequent type of intracranial aneurysms forming an intracerebral hematoma. The consequences of the hematoma—the laterality, the impact of ICH volume and size of the aneurysm with the final outcome of these patients had not been studied in detail in this location, and we focused on the analysis of these factors.

Methods

Patients with MCA aneurysms and associated intracerebral hematomas with a volume ≥10 ml were studied; these were treated from January 2006 to December 2015. During this period, more than 700 patients with spontaneous subarachnoid hemorrhage were admitted to the Department of Neurosurgery, University Hospital Brno. The data were collected from the subarachnoid hemorrhage database of the unit and from the local hospital registry. All consecutive patients at the treating center were involved in this retrospective study. We collected clinical data such as age, gender, aneurysm location, preoperative hematoma size, Hunt-Hess grade and type of surgical procedures. We focused on the analysis of the final outcome [Glasgow Outcome Scale (GOS) score] in relation to ICH volume, side of bleeding and finally the relationship between aneurysm size and the volume of ICH.

Results

Fifty-eight patients with an MCA aneurysm and ICH were included; the mean age of this series was 59.4 years. Thirty-six patients (62%) had clinical status Hunt-Hess 4–5 on admission. The mean size of the intracerebral hematoma was 47.1 ml (10–133 ml). Most frequently, in 30 patients (52%), the hematoma had bled into the temporal lobe. Fifty three patients were operated on, and 5 were treated conservatively because of their poor condition. Twenty-three patients (40%) had a favorable Glasgow Outcome Scale score, and 35 (60%) had an unfavorable outcome including 20 patients (35%) who died. Of the 53 patients operated on, 20 (38%) underwent decompressive hemicraniectomy (DHC). Patients with an unfavorable outcome had significantly larger hematomas with a median size of 54 ml, whereas those with a favorable outcome had a median size of 26 ml (p = 0.0022). Larger hematomas were found on the right side. The cutoff volume for an unfavorable outcome in ICH was 25 ml. The outcomes were not related to the side of the ICH (p = 0.42), and the aneurysm size did not predetermine the ICH volume (p = 0.3159).

Conclusion

Our study confirms the benefit of the active treatment of patients with MCA aneurysms and associated ICH. A significant proportion of these patients achieves a favorable outcome. No association between the side of bleeding and outcome was demonstrated. Hematomas larger than 25 ml have a greater tendency to lead to an unfavorable outcome. The treatment decision-making process should not differ for either side.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Abbed KM, Ogilvy CS (2003) Intracerebral hematoma from aneurysm rupture. Neurosurg Focus 15:E4

    Article  PubMed  Google Scholar 

  2. Baskaya MK, Menendez JA, Yuceer N, Polin RS, Nanda A (2001) Results of surgical treatment of intrasylvian hematomas due to ruptured intracranial aneurysms. Clin Neurol Neurosurg 103:23–28

    Article  CAS  PubMed  Google Scholar 

  3. Choi IS, David C (2003) Giant intracranial aneurysms: development, clinical presentation and treatment. Eur J Radiol 46:178–194

    Article  PubMed  Google Scholar 

  4. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737

    Article  PubMed  Google Scholar 

  5. Hernesniemi J, Vapalahti M, Niskanen M, Tapaninaho A, Kari A, Luukkonen M, Puranen M, Saari T, Rajpar M (1993) One-year outcome in early aneurysm surgery: a 14 years experience. Acta Neurochir (Wien) 122:1–10

    Article  CAS  Google Scholar 

  6. Inagawa T, Hirano A (1990) Ruptured intracranial aneurysms: an autopsy study of 133 patients. Surg Neurol 33:117–123

    Article  CAS  PubMed  Google Scholar 

  7. Jabbarli R, Reinhard M, Roelz R, Shah M, Niesen WD, Kaier K, Taschner C, Weyerbrock A, Van Velthoven V (2016) Intracerebral hematoma due to aneurysm rupture: are there risk factors beyond aneurysm location? Neurosurgery 78:813–820

    Article  PubMed  Google Scholar 

  8. Liu X, Rinkel GJ (2011) Aneurysmal and clinical characteristics as risk factors for intracerebral haematoma from aneurysmal rupture. J Neurol 258:862–865

    Article  PubMed  Google Scholar 

  9. Ljunggren B, Saveland H, Brandt L, Zygmunt S (1985) Early operation and overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 62:547–551

    Article  CAS  PubMed  Google Scholar 

  10. Mutoh T, Ishikawa T, Moroi J, Suzuki A, Yasui N (2010) Impact of early surgical evacuation of sylvian hematoma on clinical course and outcome after subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 50:200–208

    Article  Google Scholar 

  11. Natarajan SK, Sekhar LN, Ghodke B, Britz GW, Bhagawati D, Temkin N (2008) Outcomes of ruptured intracranial aneurysms treated by microsurgical clipping and endovascular coiling in a high-volume center. AJNR Am J Neuroradiol 29:753–759

    Article  CAS  PubMed  Google Scholar 

  12. Papo I, Bodosi M, Doczi T (1987) Intracerebral haematomas from aneurysm rupture: their clinical significance. Acta Neurochir (Wien) 89:100–105

    Article  CAS  Google Scholar 

  13. Pasqualin A, Bazzan A, Cavazzani P, Scienza R, Licata C, Da Pian R (1986) Intracranial hematomas following aneurysmal rupture: experience with 309 cases. Surg Neurol 25:6–17

    Article  CAS  PubMed  Google Scholar 

  14. Prat R, Galeano I (2007) Early surgical treatment of middle cerebral artery aneurysms associated with intracerebral haematoma. Clin Neurol Neurosurg 109:431–435

    Article  PubMed  Google Scholar 

  15. Rinne J, Hernesniemi J, Niskanen M, Vapalahti M (1996) Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome. Neurosurgery 38:2–11

    Article  CAS  PubMed  Google Scholar 

  16. Rosen DS, Macdonald RL, Huo D, Goldenberg FD, Novakovic RL, Frank JI, Rosengart AJ (2007) Intraventricular hemorrhage from ruptured aneurysm: clinical characteristics, complications, and outcomes in a large, prospective, multicenter study population. J Neurosurg 107:261–265

    Article  PubMed  Google Scholar 

  17. Salary M, Quigley MR, Wilberger JE Jr (2007) Relation among aneurysm size, amount of subarachnoid blood, and clinical outcome. J Neurosurg 107:13–17

    Article  PubMed  Google Scholar 

  18. Shimoda M, Oda S, Mamata Y, Tsugane R, Sato O (1997) Surgical indications in patients with an intracerebral hemorrhage due to ruptured middle cerebral artery aneurysm. J Neurosurg 87:170–175

    Article  CAS  PubMed  Google Scholar 

  19. Tapaninaho A, Hernesniemi J, Vapalahti M (1988) Emergency treatment of cerebral aneurysms with large haematomas. Acta Neurochir (Wien) 91:21–24

    Article  CAS  Google Scholar 

  20. Tokuda Y, Inagawa T, Katoh Y, Kumano K, Ohbayashi N, Yoshioka H (1995) Intracerebral hematoma in patients with ruptured cerebral aneurysms. Surg Neurol 43:272–277

    Article  CAS  PubMed  Google Scholar 

  21. Vermeulen M, van Gijn J, Hijdra A, van Crevel H (1984) Causes of acute deterioration in patients with a ruptured intracranial aneurysm. A prospective study with serial CT scanning. J Neurosurg 60:935–939

    Article  CAS  PubMed  Google Scholar 

  22. Weir B, Findlay JM (1994) Subarachnoid hemorrhage, in Neurovascular Surgery. McGraw-Hill, Inc, New York, pp 557–581

    Google Scholar 

  23. Yasargil MG (1984) Microneurosurgery, Volume 2. Georg Thieme Verlag, Stuttgart, pp 124–164

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic

    Ondrej Navratil, Kamil Duris, Vilem Juran, Eduard Neuman, Karel Svoboda & Martin Smrcka

Authors
  1. Ondrej Navratil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamil Duris
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vilem Juran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eduard Neuman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karel Svoboda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin Smrcka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ondrej Navratil.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Funding

No funding was received for this research.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Navratil, O., Duris, K., Juran, V. et al. Middle cerebral artery aneurysms with intracerebral hematoma—the impact of side and volume on final outcome. Acta Neurochir 159, 543–547 (2017). https://doi.org/10.1007/s00701-016-3070-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-016-3070-3

Keywords

Search

Navigation