Surgical treatment of middle cerebral artery aneurysms associated with associated large intracrainal hematomas

Objective To investigate the surgical management of middle cerebral artery aneurysms (MCAAs) associated with large intracrainal hematoma.Method From 2006 to 2010,a total of 15 cases of MCAAs associated with larger intracranial hematoma were treated in our department,including 6 male patients and 9 female patients ranged from 17 to 65 years old(mean age of 45 years old).Radiographic evaluations demonstrated 13 middle cerebral artery aneurysm and 1 internal carotid posterior communicating artery aneurysm among 15 cases.The associated hematoma was ranged from 25 to 60 ml and mean clot volume was 35 ml.The preoperative status on admission was Hunt - Hess grade Ⅳ in 11 patients,Ⅲ in 3 and Ⅴ in 1.Results 11 patients were brought emergently to the operating room and treated with a modification of the pterional craniotomy for clot evacuation and aneurysm clipping,decompressive craniectomy was performed in 7 patients ;3 patients were treated with immediatd endovasculor embolism at the same session of angiographic examination and emergernt hematoma clearance by small - window of skull; 1 patient was treated with clot evacuation and decompressive craniectomy in other hospital and transferred to our hospital to undergo endovascular treatment.Postoperative follow up ( ranged from 6 - 48 months) with The Glasgow Outcome Scale showed good recovery,moderate recovery,severe disability,and death in 7,4,2,and 2,respectively.Conclusions The present series suggests that early evacuation of space - occupying hematoma,aneurysm clipping and emergent decompessive cranioctomy could lead to survival with good recovery in some patients ; for patients with low grade and narrow - neck regular aneurysm,endovascular embolism at the same session of angiographic examination and emergent colt evacuation by small - window of skull would be a alternative procedure. Key words: Middle cerebral artery;  Intracranial aneurysm;  Hematoma;  Neurosurgical procedures