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Peracute surgery of aneurysms with intracerebral hematomas
1Clinic for Neurosurgery, Frankfurt/Oder, Germany.
Insights
Urgent surgical intervention for ruptured brain aneurysms with intracerebral hematomas offers the best chance for survival. Early surgery is crucial despite high risks, as no other effective treatments exist for this critical condition.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Subarachnoid hemorrhage often results from ruptured cerebral aneurysms.
- Aneurysmal subarachnoid hemorrhage can lead to significant neurological deficits and mortality.
- Early surgical intervention is critical for managing ruptured aneurysms and associated hematomas.
Observation:
- 19 patients (7.5%) with ruptured aneurysms and large intracerebral hematomas underwent surgery in a critical state (Hunt & Hess grades IV-V).
- All patients received decompressive craniotomies for hematoma evacuation and aneurysm clipping.
- Aneurysm locations included Anterior Cerebral Artery (ACA), Anterior Communicating Artery (ACoA), Middle Cerebral Artery (MCA), and Internal Carotid Artery (ICA).
Findings:
- Mortality rate was 21% (4/19) within 3 days post-surgery.
- 63% (12/19) had poor outcomes, including persistent vegetative state or severe disability.
- 37% (7/19) achieved fair to complete recovery, with 1 patient fully recovering.
Implications:
- Despite high mortality and morbidity, prompt surgical treatment for ruptured aneurysms with large hematomas is recommended.
- The study highlights the necessity of surgical intervention due to the absence of alternative effective therapies.
- Early surgical management can improve outcomes for select patients with severe aneurysmal subarachnoid hemorrhage.
Abstract:
Out of a series of 252 patients who underwent aneurysm surgery, 19 (7.5%) were operated on in a "peracute stage" in the poor grades Hunt & Hess IV (n = 11), IV-V (n = 2), and V (n = 6). All patients suffered from large aneurysmal intracerebral hematomas which were evacuated after decompressive craniotomies, all aneurysms (ACA: n = 1, ACoA: n = 4, MCA: n = 12, ICA: n = 2) could be clipped. 4 patients died within the first 3 postoperative days, 6 patients reached a poor result remaining in an apallic syndrome or a state of high invalidity, 8 obtained a fair result with personal autonomity, and 1 patient recovered completely. Although this kind of aneurysm bleeding is combined with high mortality and morbidity, we nevertheless emphasize its surgical treatment as soon as possible because of the lack of other efficient therapeutical procedures.