Comparison of Large Intrasylvian and Subpial Hematomas Caused by Rupture of Middle Cerebral Artery Aneurysm

• Published in: Neurologia medico-chirurgica Vol. 50; no. 4; pp. 281 - 285
• Main Authors: SAITO, Atsushi, AKAMATSU, Yousuke, MIKAWA, Shigeki, SUGAWARA, Takayuki, SEKI, Hirofumi
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2010; THE JAPAN NEUROSURGICAL SOCIETY
• Subjects: Adult; Aged; Aneurysm, Ruptured - complications; Aneurysm, Ruptured - pathology; Aneurysm, Ruptured - surgery; Brain Edema - etiology; Brain Edema - pathology; Brain Edema - prevention & control; Female; Hematoma - classification; Hematoma - etiology; Hematoma - pathology; Hematoma - therapy; Humans; Intracranial Aneurysm - complications; Intracranial Aneurysm - pathology; Intracranial Aneurysm - surgery; intrasylvian hematoma; Male; Middle Aged; Middle Cerebral Artery - pathology; middle cerebral artery aneurysm; Prognosis; Retrospective Studies; Severity of Illness Index; subarachnoid hemorrhage; Subarachnoid Hemorrhage - classification; Subarachnoid Hemorrhage - etiology; Subarachnoid Hemorrhage - pathology; Subarachnoid Hemorrhage - therapy; subpial hematoma; Vasospasm, Intracranial - etiology; Vasospasm, Intracranial - pathology; Vasospasm, Intracranial - prevention & control
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.50.281

The clinical characteristics of intrasylvian and subpial hematomas caused by rupture of middle cerebral artery (MCA) aneurysm were examined in 86 patients admitted to our department with subarachnoid hemorrhage (SAH) caused by ruptured MCA aneurysms. A retrospective study of 26 patients with a large hematoma associated with SAH treated surgically within 48 hours evaluated clinical grade at admission, secondary development of cerebral swelling, ratio of hematoma removal, and incidence of symptomatic vasospasm. Clinical grade on admission, age, and sex showed no significant differences. Ratio of cerebral swelling against the initial hematoma volume (p = 0.005), and incidence of symptomatic vasospasm (p = 0.041) were significantly lower, and the ratio of hematoma was significantly higher (p = 0.01) in the subpial hematoma group. Removal of hematoma was more difficult and symptomatic vasospasm was more frequent in the intrasylvian hematoma group. The clinical features of subpial and intrasylvian hematomas caused by rupture of MCA aneurysm should be considered for the better management of associated SAH.