Effects of Concomitant Intracerebral Hemorrhage on Patient Outcomes in Ruptured Distal Anterior Cerebral Artery Aneurysms

Choi, Byeoung Sam; Park, In Sung; Kang, Dong Ho; Lee, Chul Hee; Hwang, Soo Hyun; Han, Jong Woo

Abstract

OBJECTIVE
In this study, we analyzed the results of treating ruptured distal anterior cerebral artery (DACA) aneurysms surgically and reported the DACA aneurysms' characteristics and the influence of concomitant intracerebral hemorrhage (ICH) on the outcome.
METHODS
We retrospectively analyzed 24 patients with DACA aneurysms from among 430 patients who had received a diagnosis of, and undergone operations for, intracranial aneurysms in our hospital, from January 2003 to December 2008. We analyzed their age, gender, initial Glasgow coma scale (GCS) on admission, Hunt and Hess grading scale, and past medical history of hypertension or diabetes. We used computed tomography angiography (CTA) scans to investigate the location, size, multiplicity, ICH, and volume of each aneurysm and scored its surgical outcome according to the Glasgow Outcome Scale (GOS).
RESULTS
The 24 patients (8 men and 16 women) with DACA aneurysms were aged 5-73 years (mean, 52 years), and 6 had multiple aneurysms. Eleven patients had concomitant ICH, and these patients' mean hematoma volume was 15.2 cc. There were 4 patients with GCS scores from 14 to 15 and 7 patients with GCS scores below 13. Nine patients had GOS scores from 4 to 5, 1 patient had a GOS score of 3, and 1 patient, a GOS score of 1. Fisher's exact test revealed that initial GCS (P=0.03) and Hunt and Hess grade affected surgical outcomes. Concomitant ICH was not a statistically significant factor (P=0.7).
CONCLUSIONS
We found DACA aneurysms were more common in women, multiple cerebral aneurysms were frequent, and these aneurysms were not large. Clinical outcomes were associated with initial GCS and Hunt and Hess grades. ICH was more frequent in DACA aneurysms, and ICH showed no correlation with either the clinical course or the final surgical outcome.