Microsurgical Treatment And Analysis The Factors Of Influencing Prognosis Of Intrasylvian Hematomas Due To Ruptured Intracranial Aneurysms

Objective: To investigate the experiences of microsurgical treatment of intrasylvian hematomas due to ruptured intracranial aneurysms and analysis the factors of influencing prognosis of it.Methods: A retrospective review of 28 patients suffering from intrasylvian hematomas due to ruptured intracranial aneurysms diagnosed by microsurgery was performed between January 2003 and March 2009. There were 10 male patients (35.7%) and 18 female patients (64.3%) ranging between 29 to 69 years old,with a median age of 51 years old.There were 5 cases in Hunt and Hess GradeⅠ,4 cases in Hunt and Hess GradeⅡ, 11 cases in Hunt and Hess GradeⅢ, 7 cases in Hunt and Hess GradeⅣ, 1 cases in Hunt and Hess GradeV.All of the patients were taken the CT examination,and all of them had intrasylvian hematomas,18 cases of them were on the right side (64.3%). The volum of intrasylvian hematomas were between 70ml and 10ml,with a median volum of 28ml. 23 cases of them were diagnosed by CTA, and 3 cases were diagnosed by DSA, 2 cases were diagnosed during the evacuation of hematoma. Among these, 21cases (75.0%) were middle cerebral artery aneurysms, 3 cases (10.7%) were posterior communicating artery aneurysms, 1 case (3.6%) was anterior choroidal artery aneurysm, 3 cases (10.7%) were middle cerebral artery and posterior communicating artery aneurysms.The interval time between onset and microsurgical treatment: 10 cases less then 3d, 9cases 3~7d, 7cases 8~14d, 2 cases more then 14d. All of the 28 cases underwent routine operation. Discuss the relationship between prognosis and age, gender, Hunt and Hess Grade, hypertension, hematoma volum, surgical timing. The results were analysed by Fisher probabilities in 2×2 table, P<0.05 was considered to be statistically significant.Results: All of the 28 cases were microsurgically treated by pterional approach to evacuate intracerebral hematomas and to clip the ruptured aneurysms.After the surgery, 2 cases died, 5 cases got good recovery, 7 moderate and 9 severe disabilities, and 1 in vegetable state. The results of Fisher probabilities in 2×2 table show that prognosis is associated with Hunt and Hess Grade, hypertension, hematoma volum, and is not associated with age, gender, surgical timing.Conclusion: When CT shows intrasylvian hematoma,that may be due to ruptured intracranial aneurysm, the patient shoud take CTA, DSA or MRA as soon as possible, and this case may be confused with hypertensivc cerebral hemorrhage. Microsurgery is regarded as the first choice of the treatment of intrasylvian hematomas due to ruptured intracranial aneurysms.It can evacuate intracerebral hematomas and clip the ruptured aneurysms. The operation should protece the branches of middle cerebral artery and prevent postoperative cerebral infarction. Early surgical treatment still faces some difficulties. Prognosis is associated with Hunt and Hess Grade, hypertension, hematoma volum, but not associated with gender. The correlations between prognosis and surgical timing, age need further investigation.