Clinical outcome following ultra-early operation for patients with intracerebral hematoma from aneurysm rupture--focussing on the massive intra-sylvian type of subarachnoid hemorrhage.
Of 250 patients admitted with aneurysmal subarachnoid hemorrhage (SAH) from 1994 to 2000, 16 had massive intra-sylvian hematomas. To predict the useful determinants of the clinical outcome for such patients we analyzed our last 16 cases. The study was performed in 2 parts. Part 1 covered the period from 1994 to 1996 and included 5 patients who underwent early surgery. Immediately before operation, Hunt & Kosnik grade (H&K) III was observed in 1, IV in 3 and V in 1 patient. Part 2, from 1997 to 2000, included 11 patients who underwent ultra-early surgery (within 3 hours after admission) with ventriculostomy and with 2 weeks' postoperative management in the ICU. Preoperatively, there were 2 patients with H&K III, 7 with IV, and 2 with V. The results in part 1 showed that 3 out of the 5 patients had poor outcome with symptomatic vasospasm. While in Part 2, seven returned to work, 2 had minimal and 1 had severe neurological deficits with symptomatic vasospasm, and 1 died. We therefore suggest that ultra-early surgery with ventriculostomy and postoperative management in the ICU is the most useful determinant to improve the clinical outcome in the treatment of SAH patients with massive intra-sylvian hematoma.
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Department of Neurosurgery, Prefectural Shinjo Hospital, Yamagata, Japan.
Saito
K
K
Nakagawa
A
A
Endo
T
T
Suzuki
Y
Y
Shirane
R
R
D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002535:Cerebral Aqueduct; D004630:Emergencies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014696:Ventriculostomy