大脑中动脉瘤破裂引起的急性硬膜下血肿：对 25 例罕见病例的批判性分析

IF 0.7 4区医学 Q4 NEUROSCIENCES

Neurocirugia Pub Date : 2025-03-01 DOI:10.1016/j.neucir.2024.10.004

Cristina Romero-López , Javier Ros de San Pedro , Francisco Arteaga-Romero , Beatriz Cuartero-Pérez , Ignacio Martín-Schrader

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引用次数: 0

摘要

背景：急性硬膜下血肿（aSDH）是一种罕见的颅内动脉瘤破裂的表现，病理生理和预后不明确。根据文献，及时诊断、清除血肿和治疗动脉瘤可改善预后。目的是指定病理生理学，预后因素和管理这种病理。方法我们报告了23例中动脉动脉瘤破裂致aSDH病例，其中2例来自本中心。结果中位年龄51岁，女性占48%（12/25）。到达时，76%（19/25）表现为意识水平下降，55.55%（10/18）表现为神经功能缺损。动脉瘤位置为左MCA占57.14% (8/14)，MCA节段M4占76.92%(10/13)，分岔占23.07%(3/13)，中位动脉瘤大小为6 mm，中位血肿大小为10 mm，中位中线移位为9 mm，动脉瘤突出和MCA凹前位占100%(3/3)，蛛网膜下腔出血（SAH）占52.17%（12/23）。手术治疗占84%(21/25)，血管内治疗占12%(3/25),20%（5/25）需行颅骨减压切除术（DC）。格拉斯哥结局量表（GOS）为>；3/有利的占66.66%(16/24)，死亡占16.66%（4/2）。结论中动脉前凹和动脉瘤突出可能与近端动脉瘤的aSDH表现有关。当没有创伤史或耻辱时，我们应该怀疑动脉瘤起源，CT显示不成比例的大量aSDH。血肿清除术解决了单纯aSDH患者神经功能恶化的主要原因压缩机制，因此，立即清除血肿可以证明这些患者的预后更好。

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Acute subdural hematoma from ruptured middle cerebral artery aneurysm: A rare and critical analysis of 25 cases

Background

An acute subdural hematoma (aSDH) is a rare presentation of a ruptured intracranial aneurysm with pathophysiology and prognosis poorly defined. According to literature, prognosis might be improved with prompt diagnosis, hematoma evacuation and aneurysm treatment. The objective is to specify pathophysiology, prognostic factors and management of this pathology.

Methods

We reported 23 cases of aSDH due to ruptured MCA aneurysm from literature revision and 2 cases from our center.

Results

Median age was 51 years and 48% (12/25) were females. At their arrival, 76% (19/25) presented decreased level of consciousness and 55.55% (10/18) neurological deficits. Aneurysmal location was left MCA in 57.14% (8/14) and MCA segments were M4 in 76.92% (10/13) and bifurcation in 23.07% (3/13), median aneurysmal size was 6 mm, median hematoma size was 10 mm, median midline shift was 9 mm, aneurysmal projection and MCA concavity were anterior in 100% (3/3), subarachnoid hemorrhage (SAH) was present in 52.17% (12/23). The treatment was surgery in 84% (21/25), endovascular in 12% (3/25) and in 20% (5/25) decompressive craniectomy (DC) was necessary. Glasgow Outcome Scale (GOS) was >3/favorable in 66.66% (16/24) and death in 16.66% (4/2).

Conclusions

Anterior MCA concavity and aneurysmal projection might be related with aSDH presentation in proximal MCA aneurysms. We should suspect aneurysm origin when there is no history or stigma of trauma, and CT shows disproportionately massive aSDH. Hematoma evacuation solves the compressive mechanism which is the main cause of neurological deterioration in pure aSDH cases, because of that, immediate hematoma evacuation could justify better outcome in these patients.

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来源期刊

Neurocirugia 医学-神经科学

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

60 days

期刊介绍： Neurocirugía is the official Journal of the Spanish Society of Neurosurgery (SENEC). It is published every 2 months (6 issues per year). Neurocirugía will consider for publication, original clinical and experimental scientific works associated with neurosurgery and other related neurological sciences. All manuscripts are submitted for review by experts in the field (peer review) and are carried out anonymously (double blind). The Journal accepts works written in Spanish or English.