Hitoshi Fukuda1, Kosuke Hayashi1, Takafumi Moriya2, Satoru Nakashita2, Benjamin W Y Lo3, Sen Yamagata1. 1. Departments of 1 Neurosurgery and. 2. Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan; and. 3. Divisions of Neurosurgery and Critical Care Medicine, Department of Clinical Epidemiology and Biostatistics, University of Toronto and McMaster University, Hamilton, Ontario, Canada.
Abstract
OBJECT: Intrasylvian hematoma (ISH) is a subtype of intracranial hematoma caused by aneurysmal rupture and often presents with a poor initial neurological grade; it is not well studied. The aim of this study was to elucidate outcomes of aneurysmal subarachnoid hemorrhage (SAH) with ISH. METHODS: Data for 97 patients with poor-grade SAH (World Federation of Neurosurgical Societies Grade IV or V) were retrospectively analyzed from a single-center, prospective, observational cohort database. Ultra-early surgical clipping, removal of hematoma, external decompression for brain swelling, and prevention of vasospasm by cisternal irrigation with milrinone were combined as an aggressive treatment. Characteristics and clinical courses of SAH with ISH were identified. The authors also evaluated any correlations between poor admission-grade SAH and ISH with good functional outcome. RESULTS: Patients with poor admission-grade SAH and with ISH were more likely to have initial cerebral edema (p < 0.001, Mann-Whitney U-test), which significantly resolved overtime (p < 0.001, Mann-Whitney U-test). These patients had a better chance of functional survival (modified Rankin Scale scores of 1-3; OR 5.75; 95% CI 1.36-24.3; p = 0.017) at 6 months after hospital discharge, after adjustment for potential confounders such as younger age and better initial neurological grade by multivariable analysis. CONCLUSIONS: ISH predicted good functional recovery from poor-grade aneurysmal SAH.
OBJECT: Intrasylvian hematoma (ISH) is a subtype of intracranial hematoma caused by aneurysmal rupture and often presents with a poor initial neurological grade; it is not well studied. The aim of this study was to elucidate outcomes of aneurysmal subarachnoid hemorrhage (SAH) with ISH. METHODS: Data for 97 patients with poor-grade SAH (World Federation of Neurosurgical Societies Grade IV or V) were retrospectively analyzed from a single-center, prospective, observational cohort database. Ultra-early surgical clipping, removal of hematoma, external decompression for brain swelling, and prevention of vasospasm by cisternal irrigation with milrinone were combined as an aggressive treatment. Characteristics and clinical courses of SAH with ISH were identified. The authors also evaluated any correlations between poor admission-grade SAH and ISH with good functional outcome. RESULTS:Patients with poor admission-grade SAH and with ISH were more likely to have initial cerebral edema (p < 0.001, Mann-Whitney U-test), which significantly resolved overtime (p < 0.001, Mann-Whitney U-test). These patients had a better chance of functional survival (modified Rankin Scale scores of 1-3; OR 5.75; 95% CI 1.36-24.3; p = 0.017) at 6 months after hospital discharge, after adjustment for potential confounders such as younger age and better initial neurological grade by multivariable analysis. CONCLUSIONS: ISH predicted good functional recovery from poor-grade aneurysmal SAH.
Entities:
Keywords:
ICH = intracerebral hematoma; ISH = intrasylvian hematoma; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies; favorable outcome; intracerebral hemorrhage; intrasylvian hematoma; mRS = modified Rankin Scale; middle cerebral artery aneurysm; subarachnoid hemorrhage; vascular disorders; vasospasm
Authors: Jordi de Winkel; Tim Y Cras; Ruben Dammers; Pieter-Jan van Doormaal; Mathieu van der Jagt; Diederik W J Dippel; Hester F Lingsma; Bob Roozenbeek Journal: BMC Neurol Date: 2022-06-30 Impact factor: 2.903
Authors: I A Zijlstra; W E van der Steen; D Verbaan; C B Majoie; H A Marquering; B A Coert; W P Vandertop; R van den Berg Journal: Neuroradiology Date: 2018-01-22 Impact factor: 2.804