title: Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases.
abstract: BACKGROUND
  Aneurysmal subarachnoid haemorrhage (ASH) with intracerebral hematoma (ICH) has a poor prognosis. The treatment is to secure the aneurysm and do an ICH evacuation.
  
  
  OBJECTIVE
  The aim of the study was to determine if aneurysm coiling followed by ICH evacuation is a viable alternative treatment compared to exclusive surgery, regardless of the clinical or paraclinical presentations.
  
  
  METHODS
  A retrospective study was conducted between 2004 and 2014, which included 44 patients. The patients were divided up in four groups. Two were principal groups: The clipped group (aneurysm clipping with ICH evacuation) and the coiled group (aneurysm coiling, followed by ICH evacuation); and two were subgroups of the latter: Aneurysm coiling with ICH evacuation after 24 hours and ICH evacuation followed by aneurysm coiling. We studied the demographic and radiologic characteristics, and the 3-month outcome.
  
  
  RESULTS
  We included 17 patients in the coiled group: The outcome was better for the patients with World Federation of Neurosurgery (WFNS) scores of 1, 2 and 3; compared to the patients with WFNS scores 4 and 5. We included 16 patients in the clipped group: The outcome was better, compared the coiled group, for those patients with WFNS scores 4 and 5. Six patients were treated with aneurysm coiling, followed by ICH evacuation after 24 hours: 33% had a good outcome. Five patients were treated by ICH evacuation, followed by aneurysm coiling: None had a good outcome.
  
  
  CONCLUSIONS
  It was necessary to realise a prospective study to compare the outcomes of patients with WFNS scores of 1, 2 or 3; between those with aneurysm coiling followed by ICH evacuation and aneurysm clipping with ICH evacuation, to determine the potential of using the coiling first, for these patients.
authors.affiliation: Department of Neurosurgery, University of Nantes Medical Center, Nantes, France celine.salaud@chu-nantes.fr.
authors.forename: Céline
authors.initials: C
authors.lastname: Salaud
authors.affiliation: Department of Neurosurgery, University of Nantes Medical Center, Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hamel
authors.affiliation: Department of Neurosurgery, University of Nantes Medical Center, Nantes, France.
authors.forename: Tanguy
authors.initials: T
authors.lastname: Riem
authors.affiliation: Department of Neuroradiology, University of Nantes Medical Center, Nantes, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Desal
authors.affiliation: Department of Neurosurgery, University of Nantes Medical Center, Nantes, France.
authors.forename: Kevin
authors.initials: K
authors.lastname: Buffenoir
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Aneurysm coiling; case studies; clip ligation; endovascular coil embolisation; hematoma; intracerebral hematoma; neurosurgery comparison; outcomes; subarachnoid haemorrhage