Surgical treatment of ruptured middle cerebral artery aneurysms merely presenting intracranial hematomas

Abstract

Objective To investigate the features and surgical treatment of patients with intracranial hematoma caused by ruptured middle cerebral artery (MCA) aneurysms. Methods A total of 823 patients with MCA aneurysms were admitted to Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology from January 2013 to January 2017. Among them, 43 patients resulted in only intracranial hematoma without subarachnoid hemorrhage (SAH). Out of 43 patients, temporal lobe hematoma was reported in 25, frontal lobe hematoma in 8 and intracerebral and intraventricular hematomas in 10. Pre-operative angiography was applied in 33 (76.8%) patients. Among the patients without pre-operative angiography, 5 (11.6%) underwent operation because of urgent cerebral hernia and 5 (11.6%) received operation primarily due to their misdiagnosis as hypertensive intracranial hematoma. Microsurgical clipping of intracranial aneurysms was applied in all 43 patients, primary decompressive craniotomy in 8, external ventricular drainage in 4 patients and tracheotomy in 6 patients. The clinical data of these 43 patients were retrospectively analyzed. Results The grades of GOS (Glasgow outcome scale) assessed at 2 weeks post operation were Ⅰ in 3 patients, Ⅱ-Ⅲ in 2 and Ⅳ-Ⅴ in 38. Perioperative infarction occurred in 1 (2.3%) case, severer hemiplegia than preoperative conditions in 2 (4.7%) and chronic hydrocephalus in 2 (4.7%). Among 40 patients wdho survived, 4 patients was lost to follow-up, which lasted for 3-48 months, with an average of 26.4±5.6 months. Favorable outcome, based on GOS, was reported in 34 (94.4%, 34/36) cases and poor outcome in 2. Imaging follow-up revealed no aneurysm recurrence. Conclusions MCA aneurysmal hematomas without SAH are rare and easy to be misdiagnosed. However, their surgical treatment might lead to relatively good outcomes. Key words: Aneurysm, ruptured; Middle cerebral artery; Cerebral hemorrhage; Neurosurgical procedures