Microsurgical Treatment Of Ruptured Middle Cerebral Artery Aneurysms Associated With Intracranial Hematoma

Objective: To analyze microsurgical treatment outcome and related prognostic factors in patients with ruptured middle cerebral artery aneurysms associated with intracerebral hematoma.Methods: the records of 47 patients with ruptured middle cerebral artery aneurysms associated with intracerebral hematoma in our hospital from January to August 2015,all patients who were retrospectively reviewed underwent microsurgical removal of intracranial hematoma, and clipping the intracranial aneurysm; postoperative intensive care. Results: Among 47 patients,aneurysm clipping surgery was applied to 46 cases, aneurysm isolated was applied to 1 case. Among 47 patients who underwent hematoma, postoperative bleeding occured 4 cases,hydrocephalus after surgery occured 2 cases, postoperative cerebral infarction occured 1 case, seizures after surgery occured 1 case, postoperative tracheotomy 17 cases, when there are 7 cases of patients discharged from hospital in a coma, 2 cases of death, the subsequent 6-12 months of follow-up showed skull repair surgery in 4 cases, modified Rankin Score(mRS): 4 patients with 1 score,7 patients with 2 score, 9 patients with 3 score, 10 patients with 4 score,3 patients with 5 score,14 patients with 6 score(1-3 score into a good prognosis, score 4-6 into poor prognosis).Univariate statistical analysis showed that suffering from hypertension(P=0.007),intraventricular hemorrhage(P=0.018), midline shift(P=0.009), high the Hunt-Hess grade(P=0.015), high modified Rankin Score(mRS)(P=0.022), increased hematoma volume(P=0.035),are associated with poor prognosis or deaths. Analysis of decompressive craniectomy and therapeutic effect correlation was P=0.009<0.05.The difference was statistically significant.Onset to operation and therapeutic effect correlation was P=0.018<0.05. The difference was statistically significant.Conclusion: MCA aneurysm rupture with intracerebral hematoma formation carries a grave prognosis. Early Simultaneous hematoma evacuation and aneurysm clipping with craniectomy can be an effective treatment modality.