Individualized treatment for ruptured intracranial aneurysms with intracerebral hematoma and low Hunt-Hess grade
SUN Qi
BIAN Shi-chun
AN Xue-feng
WANG Yi
QIN Jie
CAI Yan-chao
LIU Yang
LEI Jie
YANG Ming
HUANG He
MA Lian-ting
Abstract：Objective To explore the surgical strategies,technical considerations,and complications management for treating low-grade(Hunt-Hess gradesⅠ～Ⅲruptured intracranial aneurysms combined with intracerebral hematoma.Methods The clinical data of 72 patients with low-grade ruptured intracranial aneurysms and concurrent intracerebral hematoma admitted between 2013 and 2023 were retrospectively analyzed.Results Microsurgical clipping was performed in 43 cases(clipping+hematoma evacuation in 24 cases;clipping+hematoma evacuation+decompressive craniectomy in 19 cases).Endovascular coiling was performed in 29 cases(coiling+hematoma drainage in 4 cases;coiling+hematoma evacuation+decompressive craniectomy in 5 cases;coiling alone in 20 cases).At discharge:the microsurgical clipping group had 34 cases(79.1%)with favorable outcomes and 9 cases(20.9%)with unfavorable outcomes(4 severe disabilities,4 vegetative states,1 death);the endovascular coiling group had 25 cases(86.2%)with favorable outcomes and 4 cases(13.8%)with unfavorable outcomes(3 severe disabilities,1 death).Postoperative follow-up(median 6 months,range 3-21 months)revealed:imaging(DSA/CTA)confirmed complete aneurysm occlusion in 34 clipping cases without recurrence;in the coiling group,24/25 cases(96.0%)achieved complete occlusion,with 1 recurrence(4.0%).Conclusion For low-grade intracranial ruptured aneurysms with intracerebral hematoma,the surgical approach should be individualized based on the specific condition of the patient.Both microsurgical clipping and endovascular embolization have good prognoses.
Keywords：Ruptured intracranial aneurysmIntracerebral hematomaMicrosurgical clippingEndovascular embolization
Publication Date：2025-04-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 193-198 )