| Objective: To investigate the clinical characteristics of anterior circulation aneurysms with hematoma,surgical strategies for different volume of hematoma due to aneurysms and the related factors of prognosis.Methods: The clinical data and follow-up data of 135 patients with hematoma due to anterior circulation aneurysms treated in our hospital from January 2013 to September 2018 were retrospectively analyzed.According to the volume of hematoma(calculated as A×B×C/2),they were divided into two types: small hematoma(≤ 25ml)and large hematoma(>25ml).The risk factors of predicting the volume of hematoma > 25 ml were analyzed by univariate and multivariate analysis.Then they were divided into hematoma evacuated group and hematoma non-evacuated group according to removing hematoma or not respectively.The influence of hematoma evacuation on the prognosis of aneurysms with hematoma was analyzed.The surgical treatment group was divided into two groups according to the 3-month mRS score: the favorable prognosis group(0-3 points)and the unfavorable prognosis group(4-6 points).The prognostic factors of surgical treatment were analyzed by univariate and multivariate analysis.Statistical Package for Social Science(SPSS)17.0 was used for statistics and Graphpad Prism 7 was used for drawing.Results: Of 135 patients with hematoma due to aneurysms,16 cases received conservative treatment and 119 received surgical treatment,including 42 cases of large hematoma aneurysms and 77 cases of small hematoma aneurysms.33 cases of large hematoma due to aneurysms underwent hematoma evacuation,30 cases of small hematoma due to aneurysms underwent hematoma evacuation.ROC working curve showed that aneurysms with the volume of hematoma more than 25.75 ml was more likely to be treated with hematoma evacuation(sensitivity 0.524,specificity 0.857).Multivariate regression analysis showed that ruptured aneurysms located in middle cerebral artery(OR=13.776,P<0.001)was the independent risk factor of aneurysms with large hematoma.Compared with subarachnoid hematoma,mixed hematoma has a higher risk of developing large hematoma(OR=5.502,P=0.004).There was no significant difference in preoperative Hunt-Hess grade,preoperative GCS score,age,gender and so on between the two groups.In the hematoma evacuated group,18 cases(60.0%)had unfavorable prognosis,while in the hematoma non-evacuated group,17 cases(36.2%)had unfavorable prognosis.There were significant differences in unfavorable prognosis between the two groups.(P=0.041).Among aneurysms with large hematoma,3(33.3%)cases of hematoma non-evacuated group had unfavorable prognosis,and 24(72.7%)cases of hematoma evacuated group bad unfavorable prognosis.There were no significant differences in unfavorable prognosis between the two groups.(P=0.073)but preoperative GCS score between the two groups showed statistical difference(P=0.011).Multivariate regression analysis showed preoperative Hunt-Hess grade(4-5 grade)(OR=9.263,P=0.008),postoperative cerebral infarction(OR=7.865,P=0.013),pulmonary infection(OR=8.619,P=0.008),postoperative bleeding(OR=24.525,P=0.011),hematoma evacuation(OR=5.520,P=0.018)and high ventricular hemorrhage score(11-32 points)(OR=9.382,P=0.021)were the independent risk factors of unfavorable prognosis of hematoma due to aneurysms with surgical treatment.Conclusion: 1.Ruptured aneurysms located in middle cerebral artery was the independent risk factor of large hematoma(>25ml)due to anterior circulation aneurysms.Compared with subarachnoid hematoma,mixed hematoma has a higher risk of developing large hematoma.2.In anterior circulation aneurysms with small hematoma,hematoma evacuation is related to unfavorable prognosis.3.Preoperative Hunt-Hess grade 4-5,postoperative cerebral infarction,pulmonary infection,postoperative bleeding,hematoma evacuation and high ventricular hemorrhage score(11-32 points)are independent risk factors for unfavorable prognosis of anterior circulation aneurysms with hematoma. |
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