Effect of Intraventricular Hemorrhage on the Surgical Outcome of Ruptured Anterior Communicating Artery Aneurysm

Abstract

Background: Several clinical conditions and factors have been proposed as the outcome predictors in patients with subarachnoid hemorrhage (SAH) following ruptured intracranial aneurysms. The impact of the intraventricular hemorrhage (IVH), which is commonly observed in the anterior communicating artery (ACoA) aneurysm, has not been discussed in detail. Objectives: The purpose of the study was to compare the outcome of early and delayed aneurysm surgery in patients with SAH regarding the presence of IVH. Methods: The study included consecutive ACoA aneurysm patients presenting with subarachnoid hemorrhage, who received microsurgical aneurysm clipping. The medical records of the patients were reviewed retrospectively. As the outcome, the Glasgow outcome score was compared between the two groups of the patients, regarding the presence or absence of the IVH. Results: 101 patients (55 males, 46 females) were enrolled in the study. The initial CT scan revealed the presence of IVH in 49 patients (mean age 52 ± 11.1 years). 52 patients (mean age 49 ± 10.7 years) had no sign of IVH. Regarding the time of surgery, 25, 44, and 32 patients underwent early (0 - 3 days), intermediate (4 - 14 days), and delayed (> 14 days) surgery from the ictus of SAH, respectively. The follow-up period was 27 months (range 0.5 - 76 months). The survival rate was 73.5% in the presence of IVH and 94.2% in patients without signs of IVH, which represented a significant difference in the outcome between the two groups (P < 0.05). Conclusions: In patients with SAH having aneurysms located in the ACoA associated with the third ventricular hemorrhage, delayed surgery might be considered in achieving a better outcome.