SURGICAL INDICATIONS IN PATIENTS WITH AN INTRACEREBRAL HEMORRHAGE DUETO RUPTURED MIDDLE CEREBRAL-ARTERY ANEURYSM

In this retrospective study, the authors analyzed surgical outcomes in patients who suffered an intracerebral hemorrhage (ICH) as a result o f a ruptured middle cerebral artery aneurysm. They studied 47 patients who underwent early aneurysm surgery and hematoma evacuation within 2 4 hours after onset of ICH. The types of ICH were classified into thre e groups according to their appearance on computerized tomography scan ning: 1) temporal ICH; 2) intrasylvian hematoma; and 3) ICH with diffu se subarachnoid hemorrhage (SAH). Overall, 25 patients (53%) achieved a favorable outcome and 18 (38%) died. Factors that could be used to p redict a favorable outcome included age less than 60 years, temporal I CH, World Federation of Neurological Surgeons Grade II or III, absence of a surgical complication, and a hematoma volume less than 25 mi. In the patients with temporal ICH, eight of nine patients achieved a goo d recovery and no patient developed a surgical complication or delayed ischemic deficit. The significant prognostic factor in patients with an intrasylvian hematoma was surgery within 6 hours after onset of sym ptoms. In patients with temporal ICH or intrasylvian hematoma, the res ults of the initial neurological examination did not accurately predic t outcome. On the other hand, in patients with ICH and diffuse SAH, th ose patients who developed an ICH with a volume greater than 25 mi had a poor prognosis. These results indicate that aggressive surgical tre atment should be performed in patients with a temporal ICH or an intra sylvian hematoma, regardless of the neurological findings on admission ; in patients with ICH and diffuse SAH, a careful review of surgical i ndications is required.