Analysis the prognostic factors of microsurgical treatment for poor-grade aneurysms associated with hematoma

Abstract

Objective To study the of microsurgical treatment for patients with poor-grade aneurysms (Hunt-Hess Ⅳ-Ⅴ) associated with hematoma and to explore the best therapeutic opportunity. Methods A retrospective analysis of 18 consecutive patients who were diagnosed as poor-grade aneurysms combined with hematoma and underwent microsurgical treatment in Wuxi Clinical Medical School of Anhui Medical University between April 2010 and June 2013 was performed. Fifteen cases underwent microsurgical treatment within 24 hours, and 3 more than 72 hours. Results All the aneurysms were occluded completely by CTA . The outcome was assessed by follow-up for 6-36 months. According to the Glasgow Outcome Scale, good recovery was observed in 4 patients, dissatisfied in 6, vegetative state in 4 and dead in 4. A poor outcome occurred in patients whose aneurysm diameter was more than 10 mm(P=0.035), intracerebral hematoma volume more than 50 ml(P=0.046) and with cerebral hernia(P=0.038) before operation. The outcome of ultra-early (within 24 hours) surgery patients was better than those received surgery over 72 hours. In 7 patients who accepted extraventricular drainage after the aneurysm was occluded, good outcome was achieved in 4, dissatisfied in 2 and 1 dead. The efficacy was better than those patients not accepted extraventricular drainage (P=0.034). Conclusions Poor-grade aneurysm was a critical condition and the prognosis weas poor. The outcome had close relationship with the size of aneurysm, volume of hematoma and cerebral hernia before operation. The ultra-early (within 24 hours) surgery combined with extraventricular drainage could improve the prognosis of patients. Key words: Intracranial aneurysm; Cranial hematoma; Microsurgery; Prognosis