Article
Managing ruptured middle cerebral artery aneurysms with concomitant intracerebral haematoma in a setting of hybrid capability
Behandlung von rupturierten Arteria Cerebri Media Aneurysmen mit asssoziierten intrazerebralen Hämatom durch ein Team aus Neurochirurgen mit endovaskulärer und mikrochirurgischer Expertise
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Authors
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Johannes Dillmann
- Diakonieklinikum Jung-Stilling, Neurosurgery, Siegen, Deutschland
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Veit Braun
- Diakonieklinikum Jung-Stilling, Neurosurgery, Siegen, Deutschland
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Ahmad Hafez
- University of Helsinki, Neurosurgery, Helsinki, Finnland
| Published: | June 4, 2021 |
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Outline
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Objective: The management of ruptured middle cerebral artery aneurysms with a concomitant large intracerebral hematoma remains a subject of debate. The rapid evolvement of endovascular techniques and availability has led to studies in the past decade, suggesting a multi-disciplinary approach with coil embolization prior to hematoma evacuation, as an alternative to the conventional purely microsurgical management. However, a multi-disciplinary set up presupposes an efficient cooperation between microsurgeons and interventional radiologists. Hybrid capability on the other hand integrates microsurgical and endovascular ability within a single team of neurosurgeons. It is the objective of this study to analyze if hybrid capability facilitates the management of this subgroup of patients possibly with a superior outcome, in comparison to published multi-disciplinary or purely microsurgical treatment approaches in the literature.
Methods: We retrospectively reviewed 28 cases of ruptured MCA aneurysms with associated ICH, treated in our institution with hybrid capability between January 2006 and December 2019. All patients were initially treated with coil embolization followed by decompressive craniotomy with or without hematoma evacuation. Clinical and radiological features were assessed and the total time to treatment documented. The outcome of patients was followed up at 6 months after discharge according to the Glasgow Outcome Score (GOS).
Results: 85.7% of the patients (n= 24) had a poor Hunt and Hess score of 4 or 5 on admission. The mean total treatment time was 238 minutes (range, 130 – 475). The overall in-hospital mortality rate was 21.4% (n= 6). Favorable clinical outcome (GOS 4 or 5) was achieved in 25.9% (7/31) at 6 months. 2 Patients were lost to follow-up.
Conclusion: Hybrid capability efficiently reduces the total treatment time in comparison to published series of multi-disciplinary or purely microsurgical approaches. A positive effect on favorable outcome was not observed.
