title: Life-Threatening Cerebral Hematoma Owing to Aneurysm Rupture.
abstract: OBJECTIVE
  To refine the surgical indications of surgery for life-threatening cerebral hematomas caused by aneurysm rupture, through the analysis of possible outcome predictors.
  
  
  METHODS
  Forty-nine consecutive patients requiring prompt clot evacuation were retrospectively reviewed. In all cases, the hematoma was equal to or greater than 60 mL. The bleeding aneurysm was located on the middle cerebral artery in 26 cases, on the internal carotid artery in 10 cases, and on the anterior cerebral artery in 13 cases; four aneurysms were giant. Six patients underwent aneurysm coiling followed by clot removal, whereas 43 patients were managed by concomitant clot evacuation and aneurysm clipping. The main clinical and radiologic features, the management paths and the treatment modalities were correlated with the outcomes. A statistical analysis was conducted.
  
  
  RESULTS
  Overall mortality was 32.6%, severe morbidity was 22.4% and 22 patients (44.8%) achieved favorable results. The short-term results were more significantly influenced by the radiological parameters than by the initial clinical conditions. The prognostic weight of the radiologic findings was partially lost for six-month results, whereby management factors gained in importance.
  
  
  CONCLUSIONS
  The bleeding severity was strongly determinant for early mortality. However, if patients can survive the initial crucial phase, their chances of a favorable outcome are not negligible. Further improvement may be possible through better patient selection and the identification of nonsalvageable subjects.
authors.affiliation: Department of Neurosurgery, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore, Milan, Italy. Electronic address: tala_nch@yahoo.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Talamonti
authors.affiliation: Service of Bio-Statistics, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Nichelatti
authors.affiliation: Department of Neurosurgery, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore, Milan, Italy.
authors.forename: Aysam Adnan
authors.initials: AA
authors.lastname: Al Mashni
authors.affiliation: Department of Neurosurgery, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Aliberti
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D020767:Intracranial Thrombosis / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D013223:Statistics as Topic; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D013525:Surgical Instruments
keywords: Intracerebral hemorrhage; Intracranial aneurysms; Microsurgical clipping; Predictors; Subarachnoid hemorrhage