title: Intrasylvian/Intracerebral Hematomas Associated with Ruptured Middle Cerebral Artery Aneurysms: A Single-Center Series and Literature Review.
abstract: OBJECTIVE
  Ruptured middle cerebral artery (MCA) aneurysms usually lead to subarachnoid hemorrhage (SAH), and several cases have shown concomitant intrasylvian or intracerebral hematomas. The objective of this study was to compare the clinical and radiographic characteristics with their different outcomes.
  
  
  METHODS
  The charts of 30 consecutive patients with ruptured MCA aneurysm-related intracranial hematoma were retrospectively reviewed. These patients were dichotomized into an intrasylvian hematoma (ISH) group and an intracerebral hematoma (ICH) group by the presence of intrahematomal contrast-enhancing vessel; for patients under open surgery, hematoma type was further confirmed by intraoperative observation. The characteristics were compared between these 2 groups (ie, age, gender, history of hypertension, history of smoking, systolic pressure at admission, hematoma volume, size and side of aneurysms, the angle between the pointing direction of the aneurysm and the MCA trunk [denoted as α], middle line shifting, treatment modality, and outcome). All the angles are measured in the anterior-posterior projection.
  
  
  RESULTS
  In our series, only hematoma volume, the angle α, and the middle line shift showed statistical significance regarding prognosis between 2 hematoma groups. An angle α between 109.0°and 216.0° is associated with ISH, whereas aneurysm with an angle beyond this range indicates ICH. In our series, patients in the ICH group had a larger hematoma volume compared with the ISH patients (33.3 ± 17.6 vs. 11.5 ± 10.5; P = 0.002). There exists no statistical difference regarding prognosis between these 2 groups, even although there is a trend toward worse recovery for patients in the ISH group (Glasgow Outcome Scale score, 3.0 ± 1.3 vs. 3.8 ± 1.9; P = 0.07).
  
  
  CONCLUSIONS
  In our series, the prognosis of patients with ICH was worse than that of patients with ISH. Early discrimination of these 2 types of hematoma helps to predict future outcome; an angle (between the pointing direction of aneurysm and the MCA trunk) between 109.0°and 216.0° is associated with ISH, whereas aneurysm with an angle beyond this range suggests ICH.
authors.affiliation: Neurosurgery Department of Qilu Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
authors.forename: Yupeng
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Neurosurgery Department of Qilu Hospital Affiliated to Shandong University, Jinan, Shandong Province, China; Neurosurgery Department of Taian Central Hospital, Taian, Shandong Province, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Hu
authors.affiliation: Neurosurgery Department of Qilu Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Xue
authors.affiliation: Neurosurgery Department of Taian Central Hospital, Taian, Shandong Province, China.
authors.forename: Mingran
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Neurosurgery Department of Qilu Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.affiliation: Neurosurgery Department of Qilu Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Deng
authors.affiliation: Neurosurgery Department of Qilu Hospital Affiliated to Shandong University, Jinan, Shandong Province, China. Electronic address: docotor-lql@hotmail.com.
authors.forename: Qinglin
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Neurosurgery Department of Qilu Hospital Affiliated to Shandong University, Jinan, Shandong Province, China. Electronic address: docotorligang@126.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D002535:Cerebral Aqueduct / Q000000981:diagnostic imaging* / Q000601:surgery; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Intracerebral hematoma; Intrasylvian hematoma; MCA aneurysms; Subarachnoid hemorrhage