DOI QR코드

DOI QR Code

Grading of Intracerebral Hemorrhage in Ruptured Middle Cerebral Artery Aneurysms

  • Shim, Yu-Shik (Department of Neurosurgery, School of Medicine, Konkuk University) ;
  • Moon, Chang-Taek (Department of Neurosurgery, School of Medicine, Konkuk University) ;
  • Chun, Young-Il (Department of Neurosurgery, School of Medicine, Konkuk University) ;
  • Koh, Young-Cho (Department of Neurosurgery, School of Medicine, Konkuk University)
  • Received : 2012.01.03
  • Accepted : 2012.05.15
  • Published : 2012.05.28

Abstract

Objective : To propose grading of intracerebral hemorrhage (ICH) in ruptured middle cerebral artery (MCA) aneurysms, which helps to predict the prognosis more accurately. Methods : From August 2005 to December 2010, 27 cases of emergent hematoma evacuation and aneurysm clipping for MCA aneurysms were done in the author's clinic. Three variables were considered in grading the ICH, which were 1) hematoma volume, 2) diffuse subarachnoid hemorrhage (SAH) that extends to the contralateral sylvian cistern, and 3) the presence of midline shifting from computed tomography findings. For hematoma volume of greater than 25 mL, we assigned 2 points whereas 1 point for less than 25 cc. We also assigned 1 point for the presence of diffuse SAH whereas 0 point for the absence of it. Then, 1 point was assigned for midline shifting of greater than 5 mm whereas 0 point for less than 5 mm. Results : According to the grading system, the numbers of patients from grade 1 to 4 were 4, 6, 8 and 9 respectively and 5, 7, 8, 4 and 3 patients belonged to Glasgow Outcome Scale (GOS) 5 to 1 respectively. It was found that the patients with higher GOS had lower ICH grade which were confirmed to be statistically significant (p<0.01). Preoperative Hunt and Hess grade and absence of midline shifting were the factors to predict favorable outcome. Conclusion : The ICH grading system composed of above three variables was helpful in predicting the patient's outcome more accurately.

Keywords

References

  1. Adams HP Jr, Kassell NF, Torner JC : Usefulness of computed tomography in predicting outcome after aneurysmal subarachnoid hemorrhage : a preliminary report of the Cooperative Aneurysm Study. Neurology 35 : 1263-1267, 1985 https://doi.org/10.1212/WNL.35.9.1263
  2. Bailes JE, Spetzler RF, Hadley MN, Baldwin HZ : Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 72 :559-566, 1990 https://doi.org/10.3171/jns.1990.72.4.0559
  3. Batjer HH, Samson DS : Emergent aneurysm surgery without cerebral angiography for the comatose patient. Neurosurgery 28 : 283-287, 1991 https://doi.org/10.1227/00006123-199102000-00017
  4. Bell BA, Kendall BE, Symon L : Computed tomography in aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 43 : 522-524, 1980 https://doi.org/10.1136/jnnp.43.6.522
  5. Benoit BG, Cochrane DD, Durity F, Ferguson GG, Fewer D, Hunter KM, et al. : Clinical - radiological correlates in intracerebral hematomas due to aneurysmal rupture. Can J Neurol Sci 9 : 409-414, 1982 https://doi.org/10.1017/S0317167100044310
  6. Brandt L, Sonesson B, Ljunggren B, Säveland H : Ruptured middle cerebral artery aneurysm with intracerebral hemorrhage in younger patients appearing moribund : emergency operation? Neurosurgery 20 : 925-929, 1987 https://doi.org/10.1227/00006123-198706000-00018
  7. Dashti R, Hernesniemi J, Niemelä M, Rinne J, Porras M, Lehecka M, et al. : Microneurosurgical management of middle cerebral artery bifurcation aneurysms. Surg Neurol 67 : 441-456, 2007 https://doi.org/10.1016/j.surneu.2006.11.056
  8. Davis JM, Davis KR, Crowell RM : Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm : prognostic significance of cranial CT. AJR Am J Roentgenol 134 : 711-715, 1980 https://doi.org/10.2214/ajr.134.4.711
  9. Fisher CM, Kistler JP, Davis JM : Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6 : 1-9, 1980 https://doi.org/10.1227/00006123-198001000-00001
  10. Forssell A, Larsson C, Rönnberg J, Fodstad H : CT assessment of subarachnoid haemorrhage. A comparison between different CT methods of grading subarachnoid haemorrhage. Br J Neurosurg 9 : 21-27, 1995 https://doi.org/10.1080/02688699550041700
  11. Horiuchi T, Tanaka Y, Takasawa H, Murata T, Yako T, Hongo K : Ruptured distal middle cerebral artery aneurysm. J Neurosurg 100 : 384-388, 2004 https://doi.org/10.3171/jns.2004.100.3.0384
  12. Inagawa T : Cerebral vasospasm in elderly patients with ruptured intracranial aneursyms. Surg Neurol 36 : 91-98, 1991 https://doi.org/10.1016/0090-3019(91)90224-W
  13. Jeong YG, Jung YT, Kim MS, Eun CK, Jang SH : Size and location of ruptured intracranial aneurysms. J Korean Neurosurg Soc 45 : 11-15, 2009 https://doi.org/10.3340/jkns.2009.45.1.11
  14. Kopera M, Majchrzak H, Kaspera W : [Prognostic factors in patients with intracerebral hematoma caused by ruptured middle cerebral artery aneurysm]. Neurol Neurochir Pol 33 : 389-401, 1999
  15. Niikawa S, Kitajima H, Ohe N, Miwa Y, Ohkuma A : Significance of acute cerebral swelling in patients with sylvian hematoma due to ruptured middle cerebral artery aneurysm, and its management. Neurol Med Chir (Tokyo) 38 : 844-848; discussion 849-850, 1998 https://doi.org/10.2176/nmc.38.844
  16. Saito A, Akamatsu Y, Mikawa S, Sugawara T, Seki H : Comparison of large intrasylvian and subpial hematomas caused by rupture of middle cerebral artery aneurysm. Neurol Med Chir (Tokyho) 50 : 281-285, 2010 https://doi.org/10.2176/nmc.50.281
  17. Shimoda M, Oda S, Mamata Y, Tsugane R, Sato O : Surgical indications in patients with an intracerebral hemorrhage due to ruptured middle cerebral artery aneurysm. J Neurosurg 87 : 170-175, 1997 https://doi.org/10.3171/jns.1997.87.2.0170
  18. Suzuki J, Komatsu S, Sato T, Sakurai Y : Correlation between CT findings and subsequent development of cerebral infarction due to vasospasm in subarachnoid haemorrhage. Acta Neurochir (Wien) 55 : 63-70, 1980 https://doi.org/10.1007/BF01808921

Cited by

  1. Comparative Results of the Patients with Intracerebral and Intra-sylvian Hematoma in Ruptured Middle Cerebral Artery Aneurysms vol.15, pp.3, 2012, https://doi.org/10.7461/jcen.2013.15.3.200
  2. Pure subdural haematoma caused by rupture of middle cerebral artery aneurysm: Case report and literature review vol.42, pp.3, 2014, https://doi.org/10.1177/0300060514524929
  3. Subarachnoid hemorrhage and intracerebral hematoma caused by aneurysms of the anterior circulation: influence of hematoma localization on outcome vol.37, pp.4, 2012, https://doi.org/10.1007/s10143-014-0560-8
  4. Importance of Hematoma Removal Ratio in Ruptured Middle Cerebral Artery Aneurysm Surgery with Intrasylvian Hematoma vol.19, pp.1, 2012, https://doi.org/10.7461/jcen.2017.19.1.5
  5. Ruptured giant aneurysm of a cortical middle cerebral artery: A case report vol.12, pp.None, 2021, https://doi.org/10.25259/sni_952_2020