前循环动脉瘤破裂引起的蛛网膜下腔出血合并血肿治疗的预测预后因素：单中心经验

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie Pub Date : 2025-02-28 DOI:10.1016/j.neuchi.2025.101655

Antoine Devalckeneer , Pierre Haettel , Philippe Poidevin , Martin Bretzner , Théo Dufresne , Alexandre Poulain , Tomas Menovsky , Nadira Delhem , Rabih Aboukaïs

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引用次数: 0

摘要

颅内动脉瘤（IA）破裂占中风的3%，并与死亡率相关。蛛网膜下腔出血合并脑血肿（CSAH）往往导致较高的死亡率；然而，最佳的治疗方法仍不清楚。本研究旨在确定预测脑前循环动脉瘤破裂所致CSAH不良预后和死亡率的因素。方法回顾性分析2017年至2019年收治的102例前循环动脉瘤破裂患者。一个多学科团队确定了治疗策略。对结果进行统计分析。结果cah与前循环动脉瘤破裂相关的双因素分析中，与发病率（1年随访时mRS >；2）和死亡率相关的显著因素为：WFNS评分严重程度、瞳孔、Tako-Tsubo和脑积水的存在。在多因素分析中，影响死亡率的显著因素是脑积水（p < 0.01）和Tako-Tsubo (p < 0.001)，影响发病率的显著因素是脑积水（p < 0.01）和血肿体积（p = 0.012）。结论本研究分析了前循环动脉瘤并发CSAH的一系列病例。我们强调及时治疗脑积水的重要性，并建议Tako-Tsubo的诊断应延迟而不是阻止治疗。根据当地的伦理标准，对于WFNS评分严重、存在滴虫、血肿（45ml）和脑积水的患者，可以考虑放弃治疗。我们的研究结果表明，危及生命的血肿最好是手术治疗，而较小的、不危及生命的病例可能受益于血管内治疗，尽管需要进一步的随机试验来验证。

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Predictive outcome factors in the treatment of subarachnoid hemorrhage with hematoma caused by ruptured anterior circulation aneurysms: A monocentric experience

Introduction

Intracranial aneurysm (IA) rupture accounts for 3% of strokes and is associated with a concerning mortality rate. Subarachnoid hemorrhage with cerebral hematoma (CSAH) often results in a higher mortality rate; however, the optimal treatment approach remains unclear. This study aims to identify factors predicting poor outcomes and mortality in cases of CSAH due to ruptured aneurysms in the anterior cerebral circulation.

Methods

This study retrospectively included 102 patients with anterior circulation aneurysm ruptures, treated between 2017 and 2019. A multidisciplinary team determined the treatment strategies. Statistical analyses were performed to assess outcomes.

Results

In the bivariate analysis of CSAH related to anterior circulation aneurysm rupture, significant factors associated with morbidity (mRS >2 at one year follow-up) and mortality were: WFNS score severity, mydriasis, Tako-Tsubo, and the presence of hydrocephalus. In the multivariate analysis, significant factors for mortality were hydrocephalus (p < 0.01) and Tako-Tsubo (p < 0.001), while significant factors for morbidity were hydrocephalus (p < 0.01) and hematoma volume (p = 0.012).

Conclusion

Our study analyzed a series of cases involving CSAH from anterior circulation aneurysms. We emphasize the importance of prompt treatment for hydrocephalus and suggest that the diagnosis of Tako-Tsubo should delay but not prevent treatment. Depending on local ethical standards, treatment abstention could be considered in patients with severe WFNS scores, the presence of mydriasis, hematoma >45 mL, and hydrocephalus. Our findings indicate that life-threatening hematomas are best managed surgically, while smaller, non-life-threatening cases may benefit from endovascular treatment, though further randomized trials are needed for validation.

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来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.