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Trends in Cerebrovascular Surgery pp 3–11Cite as

Surgical Management of Aneurysmal Hematomas: Prognostic Factors and Outcome

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Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 123))

Abstract

From 1991 until 2013, 304 patients with intracranial hematomas from aneurysmal rupture were managed surgically in our department, constituting 17 % of all patients with aneurysmal rupture. Of them, 242 patents presented with isolated intracerebral hematomas (in 69 cases associated with significant intraventricular hemorrhage), 50 patients presented with combined intracerebral and subdural hematomas (in 11 cases associated with significant intraventricular hemorrhage), and 12 presented with an isolated subdural hematoma. The surgical procedure consisted of simultaneous clipping of the aneurysm and evacuation of the hematoma in all cases. After surgery, 16 patients (5 %) submitted to an additional decompressive hemicraniectomy, and 66 patients (21 %) submitted to a ventriculo-peritoneal shunt. Clinical outcomes were assessed at discharge and at 6 months, using the modified Rankin Scale (mRS); a favorable outcome (mRS 0–2) was observed in 10 % of the cases at discharge, increasing to 31 % at 6 months; 6-month mortality was 40 %. Applying uni- and multivariate analysis, the following risk factors were associated with a significantly worse outcome: age >60; preoperative Hunt-Hess grades IV–V; pupillary mydriasis (only on univariate); midline shift >10 mm; hematoma volume >30 cc; and the presence of hemocephalus (i.e., packed intraventricular hemorrhage). Based on these results, an aggressive surgical treatment should be adopted for most cases with aneurysmal hematomas, excluding patients with bilateral mydriasis persisting after rescue therapy.

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Authors and Affiliations

  1. Section of Vascular Neurosurgery, Institute of Neurosurgery, University and City Hospital, Piazzale Stefani 1, 37128, Verona, Italy

    P. Meneghelli MD, F. Cozzi MD, A. Hasanbelliu MD & Alberto Pasqualin MD

  2. Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University and City Hospital, Verona, Italy

    F. Locatelli MD

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  1. P. Meneghelli MD
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  2. F. Cozzi MD
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  3. A. Hasanbelliu MD
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  4. F. Locatelli MD
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  5. Alberto Pasqualin MD
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Corresponding author

Correspondence to Alberto Pasqualin MD .

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Editors and Affiliations

  1. Kyoto Medical Center, National Hospital Organization, Fukakusa, Fushimi-ku, Kyoto, Japan

    Tetsuya Tsukahara

  2. Institute of Neurosurgery, Verona City Hospital, Verona, Italy

    Alberto Pasqualin

  3. Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland

    Giuseppe Esposito

  4. Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland

    Luca Regli

  5. Institute of Neurosurgery, Verona City Hospital, Verona, Italy

    Giampietro Pinna

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Meneghelli, P., Cozzi, F., Hasanbelliu, A., Locatelli, F., Pasqualin, A. (2016). Surgical Management of Aneurysmal Hematomas: Prognostic Factors and Outcome. In: Tsukahara, T., Pasqualin, A., Esposito, G., Regli, L., Pinna, G. (eds) Trends in Cerebrovascular Surgery. Acta Neurochirurgica Supplement, vol 123. Springer, Cham. https://doi.org/10.1007/978-3-319-29887-0_1

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  • DOI: https://doi.org/10.1007/978-3-319-29887-0_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29885-6

  • Online ISBN: 978-3-319-29887-0

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