Early surgical treatments of intracranial ruptured aneurysms combined with intracranial hematomas

Objective To investigate the microsurgical managements of intracranial ruptured aneurysms combined with intracranial hematomas and to observe their therapeutic efficacy. Methods A total of 32 patients with intracranial ruptured aneurysms combined with intracranial hematomas, treated in our hospital from January 2009 to January 2013, were chosen in our study; 18 male and 14 female patients ranged from 32 to 78 years old (mean age of 55 years) were enrolled, with sudden headache, vomiting, disturbance of consciousness as the first symptoms. The preoperative status on admission was Hunt-Hess grade III in 7, grade IV in 20 and grade V in 5. Radiographic imaging demonstrated 7 anterior communicating artery aneurysms, 3 posterior communicating artery aneurysms, 7 internal carotid artery aneurysms, 13 middle cerebral artery aneurysms and 2 multiple aneurysms. The associated hematoma was greater than 20 mL. All patients were brought emergently to the operating room and treated with aneurysm clipping within 72 h. Decompressive craniectomy was performed in 19 patients, and external ventricular drainage was performed in 19 patients. Results Postoperative follow up (ranged from 3-24 months) showed good recovery, moderate recovery, severe disability, persistent vegetative state and death in 6, 12, 11, 0 and 2, respectively, graded by Glasgow Outcome Scale; the remaining one patient was lost to follow-up. The percentage of good prognosis in patients with preoperative Hunt-Hess grade of III grade (84.6%) was higher than that of patients with IV-V grade (36.8%, P<0.05). Conclusions Early evacuation of space-occupying hematoma, aneurysm clipping and emergent decompessive cranioctomy could lead to survival with good recovery in some patients. Key words: Intracranial aneurysm; Hematoma; Microsurgical operation