Summary
Of 250 patients admitted with aneurysmal subarachnoid hemorrhage (SAH) from 1994 to 2000, 16 had massive intra-sylvian hematomas. To predict the useful determinants of the clinical outcome for such patients we analyzed our last 16 cases. The study was performed in 2 parts. Part 1 covered the period from 1994 to 1996 and included 5 patients who underwent early surgery. Immediately before operation, Hunt & Kosnik grade (H&K) III was observed in 1, IV in 3 and V in 1 patient. Part 2, from 1997 to 2000, included 11 patients who underwent ultra-early surgery (within 3 hours after admission) with ventriculostomy and with 2 weeks’ postoperative management in the ICU. Preoperatively, there were 2 patients with H&K III, 7 with IV, and 2 with V. The results in part 1 showed that 3 out of the 5 patients had poor outcome with symptomatic vasospasm. While in Part 2, seven returned to work, 2 had minimal and 1 had severe neurological deficits with symptomatic vasospasm, and 1 died. We therefore suggest that ultra-early surgery with ventriculostomy and postoperative management in the ICU is the most useful determinant to improve the clinical outcome in the treatment of SAH patients with massive intra-sylvian hematoma.
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References
Batjer HH, Samson DS (1991) Emergent aneurysm surgery without cerebral angiography for the comatose patient. Neurosurgery 28(2): 283–287
Hosoda K, Fujita S, Kawaguchi T, Shose Y, Hamano S, Iwakura M (1999) Effect of clot removal and surgical manipulation on regional cerebral blood flow and delayed vasospasm in early aneurysm surgery for subarachnoid hemorrhage. Surg Neurol 51(1): 81–88
Inagawa T, Yamamoto M, Kamiya K (1990) Effect of clot removal on cerebral vasospasm. J Neurosurg 72(2): 224–230
Ljunggren B, Saveland H, Brandt L, Zygmunt S (1985) Early operation and overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 62(4): 547–551
Nowak G, Schwachenwald D, Schwachenwald R, Kehler U, Müller H, Arnold H (1998) Intracerebral hematomas caused by aneurysm rupture. Experience with 67 cases. Neurosurg Rev 21(1): 5–9
Takahashi S, Sonobe M, Nagamine Y (1981) Early operations for ruptured intracranial aneurysms — comparative study with computed tomography. No Shinkei Geka 9(2): 151–156
Tapaninaho A, Hernesniemi J, Vapalahti M (1988) Emergency treatment of cerebral aneurysms with large haematomas. Acta Neurochir (Wien) 91(1–2): 21–24
Yoshimoto Y, Wakai S, Satoh A, Hirose Y (1999) Intaparenchymal and intrasylvian haematomas secondary to ruptured middle cerebral artery aneurysms: prognostic factors and therapeutic considerations. Br J Neurosurg 13(1): 18–24
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© 2002 Springer-Verlag
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Su, CC., Saito, K., Nakagawa, A., Endo, T., Suzuki, Y., Shirane, R. (2002). Clinical Outcome Following Ultra-Early Operation for Patients with Intracerebral Hematoma from Aneurysm Rupture — Focussing on the Massive Intra-Sylvian Type of Subarachnoid Hemorrhage. In: Yonekawa, Y., Sakurai, Y., Keller, E., Tsukahara, T. (eds) New Trends in Cerebral Aneurysm Management. Acta Neurochirurgica Supplements, vol 82. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6736-6_13
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DOI: https://doi.org/10.1007/978-3-7091-6736-6_13
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-7396-1
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