Surgical Management of Aneurysmal Hematomas in the Presence of Brain Herniation on Arrival: A Single-Center Case Series Analysis
| Autor: | Minqing Wang, Xiao-fei Wang, Chao Han, Xu Zhao, Deguang Xing, Chengwei Wang |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Decompressive Craniectomy medicine.medical_specialty Tomography Scanners X-Ray Computed Subarachnoid hemorrhage Computed Tomography Angiography Brain herniation 03 medical and health sciences 0302 clinical medicine Hematoma Mydriasis Humans Medicine Glasgow Coma Scale cardiovascular diseases 030212 general & internal medicine Aged Retrospective Studies business.industry Glasgow Outcome Scale Intracranial Aneurysm Retrospective cohort study Emergency department Middle Aged Subarachnoid Hemorrhage Surgical Instruments medicine.disease Surgery Treatment Outcome Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 114:e468-e476 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2018.03.011 |
| Popis: | Objectives To assess the outcomes in aggressively treated patients with aneurysmal intracerebral hematoma (ICH) and signs of brain herniation, and to investigate possible predictive factors. Methods This retrospective study included 43 patients with aneurysmal ICH who presented to the Emergency Department with brain herniation and received aggressive surgical treatment between 2008 and 2016. Emergency surgical clipping, hematoma removal, and external decompression were combined as an aggressive surgical treatment. Outcomes were assessed using in-hospital survival and the Glasgow Outcome Scale at a 6-month follow-up. Results All the patients were World Federation of Neurological Societies grade V on presentation. The mean hematoma volume was 59.1 ± 16.5 mL. The in-hospital mortality rate was 48.8%. At the 6-month follow-up, favorable outcomes were achieved in 7 patients (16.3%). Significant factors related to death included bilateral mydriasis, lower initial Glasgow Coma Scale (GCS) score, larger hematoma volume, and no recovery of pupil reactivity after surgery. Bilateral restoration of pupil reactivity and higher initial GCS score were associated with 6-month favorable outcomes. Patients with an intrasylvian hematoma were more likely than those with an intraparenchymal hematoma to achieve a favorable outcome (62.5% vs. 5.7%; P = 0.001). Conclusions Our data indicate that the protocol of aggressive surgical treatment in patients with a herniated aneurysmal ICH might be warranted. Despite mydriasis, favorable outcomes might be achieved in some patients. However, careful individual patient-centered decision making is essential, particularly when bilateral pupil dilation persists. |
| Databáze: | OpenAIRE |
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