Publication year: 2012
Source:World Neurosurgery
Bradley N. Bohnstedt, Ha Son Nguyen, Charles G. Kulwin, Mohammadali M. Shoja, Gregory M. Helbig, Thomas J. Leipzig, Troy D. Payner, Aaron A. Cohen-Gadol
Objective Few studies have investigated the implications of intracerebral hematoma (ICH) due to rupture of a middle cerebral artery (MCA) aneurysm and patient outcomes. The authors hypothesized that patients with Hunt-Hess (HH) grade IV-V may not benefit from aggressive measures. To evaluate this hypothesis, the authors undertook the following study. Methods A prospectively acquired aneurysm database was examined. We found 144 patients who harbored a ruptured MCA aneurysm and suffered from ICH or intrasylvian hematoma (ISH) with or without SAH. The mean age of our patients was 52.5 years (range, 10–82 years) with 87 women and 57 men. Of these, 122 (84.7%) underwent a combination of interventions, including clip ligation, hematoma evacuation, and/or endosaccular coiling; most patients underwent clip ligation at the same time their hematoma was evacuated. The discharge information was not available for two patients. We examined significant associations among presenting details (age, sex, admission HH grade, etc.) and patients' final outcome. Results The total in-hospital mortality rate was 49% (70 of 142 patients); 42% (51 of 120) for the patients who underwent an intervention and 86.4% (19 of 22) for those who did not undergo any intervention. Among our patients, approximately 52% with an admission HH grade of IV/V died in-hospital following surgery, while 21% with admission HH grade of I-III expired during the same time. In the patient cohort with presenting with HH grade IV and V, 4% (3 of 76) demonstrated Glasgow outcome scale (GOS) 4-5 at discharge, while 15% (12 of 78) displayed GOS 4-5 at 6-month follow-up. Age and sex did not affect outcome. Conclusions Aggressive clip ligation and hematoma evacuation remains a reasonable option for patients suffering from an ICH associated with a ruptured MCA aneurysm. Admission HH grade is the primary prognostic factor for outcome among this patient population as more than half of patients with HH grade IV and V expired during their hospitalization despite aggressive treatment of their hematoma and aneurysm; long-term functional outcome was poor in up to 85% of surviving patients with HH grade IV-V. It may be beneficial to discuss these prognostic factors with the family before implementing aggressive measures.
Source:World Neurosurgery
Bradley N. Bohnstedt, Ha Son Nguyen, Charles G. Kulwin, Mohammadali M. Shoja, Gregory M. Helbig, Thomas J. Leipzig, Troy D. Payner, Aaron A. Cohen-Gadol
Objective Few studies have investigated the implications of intracerebral hematoma (ICH) due to rupture of a middle cerebral artery (MCA) aneurysm and patient outcomes. The authors hypothesized that patients with Hunt-Hess (HH) grade IV-V may not benefit from aggressive measures. To evaluate this hypothesis, the authors undertook the following study. Methods A prospectively acquired aneurysm database was examined. We found 144 patients who harbored a ruptured MCA aneurysm and suffered from ICH or intrasylvian hematoma (ISH) with or without SAH. The mean age of our patients was 52.5 years (range, 10–82 years) with 87 women and 57 men. Of these, 122 (84.7%) underwent a combination of interventions, including clip ligation, hematoma evacuation, and/or endosaccular coiling; most patients underwent clip ligation at the same time their hematoma was evacuated. The discharge information was not available for two patients. We examined significant associations among presenting details (age, sex, admission HH grade, etc.) and patients' final outcome. Results The total in-hospital mortality rate was 49% (70 of 142 patients); 42% (51 of 120) for the patients who underwent an intervention and 86.4% (19 of 22) for those who did not undergo any intervention. Among our patients, approximately 52% with an admission HH grade of IV/V died in-hospital following surgery, while 21% with admission HH grade of I-III expired during the same time. In the patient cohort with presenting with HH grade IV and V, 4% (3 of 76) demonstrated Glasgow outcome scale (GOS) 4-5 at discharge, while 15% (12 of 78) displayed GOS 4-5 at 6-month follow-up. Age and sex did not affect outcome. Conclusions Aggressive clip ligation and hematoma evacuation remains a reasonable option for patients suffering from an ICH associated with a ruptured MCA aneurysm. Admission HH grade is the primary prognostic factor for outcome among this patient population as more than half of patients with HH grade IV and V expired during their hospitalization despite aggressive treatment of their hematoma and aneurysm; long-term functional outcome was poor in up to 85% of surviving patients with HH grade IV-V. It may be beneficial to discuss these prognostic factors with the family before implementing aggressive measures.
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