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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Aneurysm-related subarachnoid hemorrhage and intracerebral hematoma of the anterior circulation: characteristics, prognostic factors and outcome

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  • M. Bruder - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • E. Güresir - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • H. Vatter - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 039

doi: 10.3205/11dgnc260, urn:nbn:de:0183-11dgnc2607

Published: April 28, 2011

© 2011 Bruder et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The presence and size of intracerebral hematoma (ICH) in patients with subarachnoid hemorrhage (SAH) is a known predictor of unfavorable outcome. However, a significant number of patients still do achieve a favorable outcome. The objective of the current study was to analyze the impact of the ICH location, Fisher grading and clinical features on treatment and outcome.

Methods: Data on 126 patients with aneurysmal subarachnoid hemorrhage and ICH were prospectively entered in a database. SAH and ICH were diagnosed by computed tomography scan before aneurysm occlusion. Patients were analyzed for ICH location. Patients were stratified into good (Hunt and Hess I-III) versus poor (Hunt and Hess IV-V) grade. Outcome was assessed according to the modified Rankin Scale (mRs) at 6 months.

Results: 74 patients (58.7%) presented with frontal hematoma, 40 patients (31.8%) with temporal and 12 patients (9.5%) with perisylvian hematoma. 22 of 126 patients (17.5%) had an isolated aneurysm related ICH. Overall, 45 patients presented in good grade. 27 of 40 good grade patients (60%) versus (vs.) 17 of 81 poor grade patients (21.3%) achieved a favorable outcome (mRs 0-2; P<0,001). 23 patients (31.1%) with frontal ICH, 2 patients (16.7%) with perisylvian ICH, and 19 patients (47.5%) with temporal ICH achieved a favorable outcome. According to admission Fisher grading, favorable outcome was achieved in 8 of 22 patients (36.4%) with isolated ICH vs. 36 of 104 patients (34.6%) with III° Fisher bleeding (P=1.0). In a multivariate analysis, unfavorable outcome was associated with poor admission status (P=0.03) and early hydrocephalus (P=0.03), but not with ICH location.

Conclusions: The current data confirms that a significant number of patients (34.9%) with ICH after aneurysm rupture achieve a favorable outcome. Favorable outcome was associated with good clinical status on admission and absence of early hydrocephalus regardless of ICH location. Early treatment with hematoma evacuation and aneurysm obliteration seem to be mandatory to achieve a favorable outcome. Careful decision making is necessary when signs of cerebral herniation persisted for a long time.