Analysis on secondary intracerebral hematoma in the operating area after clipping aneurysm in an early surgery

Abstract

Objective Investigate the reasons for secondary intracranial hematoma, formed finally due to some rare refractory small hemorrhage of brain in the initial operating area after successfully clipping anearysm in an early surgery. Method 134 cases with intracranial aneurysm underwent clipping through direct cranioctomy were retrospected,5 cases(3.7%) of which were subject to carofnl observation for contusion and severity of frontal lobe (including those after decompression), exudation of wound surface, and hemostasis during the surgery, as well as injury severity of brain due to brain spatula. For one case of them it was hard to control bleeding, a part of contusion and laceration was collected and sent for pathological examination in advance; for the other 4 cases, hematonm was removed through a second cranioctomy, and a part of cerebral tissue was sent for pathological examination, for the purpose of obtaining comprehensive knowledge of the reasons for hemorrhage from pathology, etc. Results Of the 5 cases, it was found that, subarachnoid hemorrhage, obvious brain swelling, and purplish' brain appearance occurred, injury to different extent due to brain spatula occurred during the surgery, and the pathological manifestations were mainly of local hemorrhage. A concentrated area of irregular blood vessels was found around the hemorrhagic site, mainly including minute veins and capillaries; those blood vessels were diffusively dilated, and thrombosis occurred in some of them; the walls of some blood vessels were of inconsistent thickness, and a small neutrophil infiltration was found in the walls. Conclusions Occurrence of such intracerebral hematoma, and early hard cerebral swelling due to aneurysm hemorrhage are associated with patient's inherent small vascular malformation and brain spatula stretch injury during the surgery; it may be found through careful observation after the surgery, and timely treatment is effective. Key words: Intracranial aneurysm; Initial operation; Hematoma