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. 2018 Mar;60(3):335-342.
doi: 10.1007/s00234-018-1978-4. Epub 2018 Jan 22.

Ruptured middle cerebral artery aneurysms with a concomitant intraparenchymal hematoma: the role of hematoma volume

I A Zijlstra  1 , W E van der Steen  2   3 , D Verbaan  4 , C B Majoie  2 , H A Marquering  2   5 , B A Coert  4 , W P Vandertop  4 , R van den Berg  2
Affiliations

Ruptured middle cerebral artery aneurysms with a concomitant intraparenchymal hematoma: the role of hematoma volume

I A Zijlstra et al. Neuroradiology. 2018 Mar.

Abstract

Purpose: To study whether clinical outcome data from our patient cohort could give support to the new recommendation in the AHA/ASA guidelines for the management of aneurysmal subarachnoid hemorrhage that states "that microsurgical clipping may receive increased consideration in patients with ruptured middle cerebral artery (MCA) aneurysms and large (>50 mL) intraparenchymal hematomas", while clinical outcome data supporting this recommendation are sparse.

Methods: We reviewed the clinical and radiological data of 81 consecutive patients with MCA aneurysms and concomitant hematomas admitted between January 2006 and December 2015. The relation between (semi-automatically quantified) hematoma volume (< or > 50 ml), neurological condition on admission (poor: GCS < 8 or non-reactive pupils), treatment strategies (no treatment, coiling, or clipping with or without decompression and/or clot removal), and outcome (favorable: mRS score 0-3) was evaluated.

Results: Clinical outcome data were available for 76 patients. A significant difference in favorable outcome (17 vs 68%) was seen when comparing patients with poor and good neurological condition on admission (p < 0.01). Patients with hematomas > 50 ml had similar outcomes for coiling and clipping, all underwent decompression. Patients with hematomas < 50 ml did not show differences in favorable outcome when comparing coiling and clipping with (33 and 31%) or without decompression (90 and 88%).

Conclusion: Poor neurological condition on admission, and not large intraparenchymal hematoma volume, was associated with poor clinical outcome. Therefore, even in patients with large hematomas, the neurological condition on admission and the aneurysm configuration seem to be equally important factors to determine the most appropriate treatment strategy.

Keywords: Aneurysm; Hematoma; Middle cerebral artery; Ruptured; Subarachnoid hemorrhage.

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Conflict of interest statement

Funding

No funding was received for this study.

Conflict of interest

CM received a grant from the Dutch Heart Foundation (paid to institution); AMC received funds from Stryker for consultations by CM. HM is a founder and shareholder of Nico-lab. RB has a consultancy agreement with Codman.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Figures

Fig. 1
Fig. 1
Neurological condition and hematoma volume in relation to clinical outcome after 3–6 months’ follow-up in 73* patients with a ruptured MCA aneurysm and an associated intraparenchymal hematoma. *Data missing in three patients. No significant differences were found in the analysis of all the variables. mRS modified Rankin Scale
See this image and copyright information in PMC

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