Risk-factor Analysis And Treatment Research On Intracranial Hematomas Caused By Ruptured Middle Cerebral Artery Aneurysms

BackgroundIntracranial aneurysm rupture is one of the most common diseases in department of neurosurgery,which often causes subarachnoid hemorrhage(SAH).With acute onset and severe illness,it frequently associates with intracranial hematoma(IH),and thus leads to cerebral herniation,resulting in significantly increased morbidity and mortality.According to statistics,about 34%-43.7%of IHs were caused by ruptured middle cerebral artery aneurysms(MCANs),while 30%-50%ruptured MCANs were complicated with intracranial hematomas.However,the factors that influence whether ruptured MCANs cause pure SAH or IHs are still unclear.In addition,both aneurysm clipping and endovascular embolization are commonly used to treat ruptured MCANs,but the clinical efficacies of these two treatments on the patient with pure SAH or IHs still need further analysis.Objective:To analyze the risk-factors of IH formation after MCAN rupture,and to explore the efficacies of different treatment methods on patients with ruptured MCANs complicated with pure SAH or IHs.Method:A retrospective analysis of 92 MCAN rupture cases from February 2010 to February 2017 in the Department of Neurosurgery of Qilu Hospital affiliated to Shandong University,of which 60 cases showed simple SAH(SAH group),32 cases were complicated with IH(IH group),was performed.All Cases were collected relevant information:1.Basic conditions,including age,gender,systolic blood pressure(SBP),diastolic blood pressure(DBP)and hypertension history;2.Inducements;3.Responsible aneurysm characteristics,including size(S),high(H),maximum height(Hmax),neck width(D),aspect ratio(AR),size ratio(SR),aneurysm angle(AA),directing,shape,rupture time,side and daughter sac;4.Parent artery characteristics,including aneurysm location and parent artery diameter(Dv);5.blood coagulation,including platelet counts(PLT),activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB)and thrombin time(TT).To find independent risk factors of IH caused by MCAN rupture,T tests(for numerical variable)or single factor chi square tests(for classification variables)were done,and then Logistics multivariate analysis was performed for factors with significant difference.To clarify the current optional inclination in treatment methods,we analyzed the treatment received by patients in SAH group and IH group with chi square test.Then the efficacy and prognosis were assessed with GOS score,and t test was done to compare the efficacies of aneurysm clipping and endovascular embolization respectively for MCAN rupture patients complicated with pure SAH or IH.Result:92 patients were included in this study.Univariate analysis showed that age(t=0.20,P=0.842),gender(χ2=0.14,P=0.708),hypertension history(χ2=7.21,P=0.125),inducements(χ2=1.75,P=0.186),AR(t=-0.04,P=0.997),AA(t=-0.62,=0.559),responsible aneurysm directing(χ2=0.90,P=0.828),shape(χ2=0.04,P=0.851),rupture time(t=0.42,P=0.679),side(χ2=0.02,P=0.894),location(χ2 =0.48,P=0.489),Dv(t=-0.07,P=0.939),PT(t=-1.76,P=0.861),APTT(t=-0.08,P=0.935),FIB(t=-1.48,P=0.142)had no significant difference,while for SBP(t=-4.36,P=3.49×10-5),DBP(t=-2.56,P=0.012),responsible aneurysm size(t=-5.07,P=1.27×10-5),height(t=-4.15,P=1.49×10-4),maximum height(t=-4.69,P=2.81×10-5),neck width(t=-4.64,P=3.41×10-4),SR(t=-3.15,P=0.003),daughter sac(χ2=6.25,P=0.012),TT(t=2.70,P=0.008),PT(t=-2.98,P=0,004),the differences between the two groups were statistically significant.Logistics multivariate analysis showed that SBP(OR=1.08,P=0.001),responsible aneurysm size(OR=1.110,P=2.059×10-4),daughter sac(OR=8.590,P=0.032)and TT(OR=0.387,P=5.538×10-5)were independent risk factors for IH after MCAN rupture,While DBP,responsible aneurysm height,maximum height,neck width,SR and PT were excluded.In 60 SAH cases,37 patients received aneurysm clipping,1 patient rejected surgical treatment,1 patient received aneurysmectomy,and 21 patients were treated with endovascular embolization.In 32 patients with IHs.28 patients received aneurysm clipping,1 patient received aneurysmectomy,and interventional embolization was performed in 3 cases.In terms of aneurysm clipping and endovascular embolization,current clinical treatment tended to choose aneurysm clipping(χ2=7.22,P=0.007)for MCAN rupture patients with IHs.In general,prognosis of IH group was significantly worse than SAH group(t=3.85,P=2.22×10-4),especially for patients who received aneurysm clipping(t=3.13,P=0.003),while the difference was not significant due to small sample for interventional embolization(t=1.45,P=0.160).No significant difference was found in the prognosis between patients who received aneurysm clipping and interventional embolization neither in SAH group(t=0.18,P=0.858)nor IH group(t=0.08,P=0.937).Conclusion:1.High SBP,large responsible aneurysm,daughter sac and low TT are independent risk factors for IH formation after MCAN rupture.2.Currently,aneurysm clipping is more popular for MCAN rupture patients with IHs than interventional embolization.3.MCAN rupture patients with IHs showed worse prognosis than patients with pure SAH.Neither in SAH group nor IH group,no significant difference of efficacy between aneurysm clipping and interventional embolization was found.