• Carmelo Lucio Sturiale, Alba Scerrati, Luca Ricciardi, Oriela Rustemi, Anna Maria Auricchio, Nicolò Norri, Amedeo Piazza, Fabio Ranieri, Alberto Benato, Alberto Tomatis, Alessio Albanese, Annunziato Mangiola, Vincenzo Di Egidio, Donato Carlo Zotta, Marco Farneti, Enrico Marchese, Antonino Raco, Lorenzo Volpin, and Gianluca Trevisi.
• Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: cropcircle.2000@virgilio.it.
• World Neurosurg. 2023 May 1; 173: e821e829e821-e829.

BackgroundSubarachnoid hemorrhage (SAH) due to a middle cerebral artery (MCA) aneurysm rupture is often associated with an intracerebral hematoma (ICH) or intrasylvian hematoma (ISH).MethodsWe reviewed 163 patients with ruptured MCA aneurysms associated with pure SAH or SAH plus ICH or ISH. The patients were first dichotomized according to the presence of a hematoma (ICH or ISH). Next, we performed a subgroup analysis comparing ICH versus ISH to explore their relationship with the most relevant demographic, clinical, and angioarchitectural features.ResultsOverall, 85 patients (52%) had a pure SAH, and 78 (48%) had presented with an associated ICH or ISH. No significant differences were observed in the demographics or angioarchitectural features between the 2 groups. However, the Fisher grade and Hunt-Hess score were higher for the patients with hematomas. A good outcome was observed in a higher percentage of patients with pure SAH compared with those with an associated hematoma (76% vs. 44%), although the mortality rates were comparable. Age, Hunt-Hess score, and treatment-related complications were the main outcome predictors on multivariate analysis. Patients with ICH appeared worse clinically compared with those with ISH. We also found that older age, a higher Hunt-Hess score, larger aneurysms, decompressive craniectomy, and treatment-related complications were associated with poor outcomes among the patients with an ISH, but not an ICH, which appeared, per se, as a more severe clinical condition.ConclusionsOur study has confirmed that age, Hunt-Hess score, and treatment-related complications influence the outcome of patients with ruptured MCA aneurysms. However, in the subgroup analysis of patients with SAH associated with an ICH or ISH, only the Hunt-Hess score at onset appeared as an independent predictor of the outcome.Copyright © 2023 Elsevier Inc. All rights reserved.

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