J Korean Neurosurg Soc.  2012 Aug;52(2):80-84. 10.3340/jkns.2012.52.2.80.

The Meaning of the Prognostic Factors in Ruptured Middle Cerebral Artery Aneurysm with Intracerebral Hemorrhage

• Oh JW
• Lee JY
• Lee MS
• Jung HH
• Whang K
• Brain Research Group

• KMID: 2190543
• DOI: http://doi.org/10.3340/jkns.2012.52.2.80

Abstract

OBJECTIVE
This study analyzed the relationship between prognosis and multiple clinical factors of ruptured middle cerebral artery (MCA) aneurysm with intracerebral hemorrhage (ICH), to aid in predicting the results of surgical treatment.
METHODS
Enrolled subjects were 41 patients with ruptured MCA aneurysm with ICH who were treated with surgical clipping. Clinical factors such as gender, age, and initial Glasgow coma scale were assessed while radiological factors such as the volume and location of hematoma, the degree of a midline shift, and aneurysm size were considered retrospectively. Prognosis was evaluated postoperatively by Glasgow outcome scale.
RESULTS
Age and prognosis were correlated only in the groups with ICH over 31 mL or ICH at the frontal lobe or sylvian fissure. When initial mental status was good, only patients with ICH on the temporal lobe had a better prognosis. If the midline shift was less than 4.5 mm, the probability of better prognosis was 95.5% (21 of 22). If the midline shift was more than 4.5 mm, the probability of poor prognosis was 42.1% (8 of 19). Patients with ICH less than 31 mL had higher survival rates, whereas if the ICH was more than 31 mL, 41.2% (7 of 17) had a poor clinical pathway.
CONCLUSION
Even if the initial clinical condition of the patient was not promising, by carefully examining and taking into account all factors, neurosurgeons can confidently recommend surgical treatment for these patients.

Keyword

Ruptured middle cerebral artery aneurysm; Intracerebral hemorrhage; Prognostic outcome

MeSH Terms

Aneurysm
Cerebral Hemorrhage
Frontal Lobe
Glasgow Coma Scale
Hematoma
Hemorrhage
Humans
Intracranial Aneurysm
Middle Cerebral Artery
Prognosis
Retrospective Studies
Surgical Instruments
Survival Rate
Temporal Lobe

Figure

• 

  Fig. 1 Type of intracerebral hemorrhage. Axial CT scans, preoperation. A : Temporal type. B : Frontal type. C : Sylvian fissure type.

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