SURGICAL TREATMENT OF INTRACRANIAL HEMATOMAS IN RUPTURED ARTERIAL ANEURYSMS
V.V. Krylov, V,G, Dashyan, M.S. Gelfenbein, V.N. Shelkovsky, V.G. Rurua, R.A. Karamyshev, S.A. Vasilyev
Sklifosovsky Research Institute of Emergency Care
The results of the analysis of 161 cases with intracranial hematomas (ICH) caused by ruptures of arterial aneurysms (AA) of the brain are given. Presence of compression and dislocation syndromes as well as a risk of repeated bleeding from AA were an indication for an operation. Among 130 operated patients good, satisfactory and bad results were seen in 32%, 19% and 11% respectively. Operative mortality was equal to 38%. Mortality in a group of patients who were not subject to operation it was 93.5%.
Mortality in operated patients with ventricular hemorrhage and without it was 59% and 19.6% respectively. Operative mortality in cases with hematoma of 11-40 ml was 33% more than 40 ml – 52%. Mortality in patients with hematoma of less than 10 ml was conditioned by ischemia of the brain. There were no fatal outcomes in severity of the IInd, they were watched in 35%, 33% and 78% in severity of the IIIrd, IVth and Vth degree respectively. An operation performed during the first 3 days after hemorrhage resulted in mortality of 58%, on the 4-7th day – 25%, on the 8-14th day – 27%, later – 10,5%. Operative mortality in dislocation of median structures was as follows: less than 5 mm –33%, from 5 up o 10 mm – 36%, more than 10 mm –100%.
Operations made on the first day after hemorrhage were considered to be a stage of resuscitative measures. Surgical intervention in patients with an extremely severe state was the only chance of survival. The authors consider that risk factors in surgical treatment of patients with ICH caused by aneurysm rupture include: inhibition of consciousness up to coma, a state severity of the Vth degree according to Hunt-Hess scale, hematoma of more than 60 ml, transverse dislocation of median structures of the brain equal to more than 10 mm, multisegmentary angiospasm, ventricular hemorrhage.