• Thomas Metayer, Chloe Dumot, Florian Bernard, Pierre-Jean Le Reste, Anne-Laure Bernat, Helene Cebula, Charles-Henry Mallereau, Charles Peltier, Caroline le Guerinel, Denis Vivien, Michel Piotin, Evelyne Emery, Vianney Gillard, Arthur Leclerc, Elsa Magro, Francois Proust, Isabelle Pelissou-Guyotat, Stephane Derrey, Sorin Aldea, Charlotte Barbier, Alin Borha, Lawrence Nadin, Anais R Briant, and Thomas Gaberel.
• Department of Neurosurgery, University Hospital of Caen, Caen, France. thomas.metayer@neurochirurgie.fr.
• Neurocrit Care. 2023 Aug 1; 39 (1): 162171162-171.

BackgroundRuptured middle cerebral artery aneurysm (MCAa) can lead to intracerebral hematoma, and surgical evacuation can be performed in these cases. MCAa can be treated by clipping or before by endovascular therapy (EVT). Our objective was to compare the impact on the functional outcome of MCAa in patients with intracerebral hematoma requiring evacuation.MethodsThis is a multicenter, retrospective, cohort study with nine French neurosurgical units from January 1, 2013, to December 31, 2020. All participants were adult patients who required evacuation of an intracerebral hematoma. We looked for risk factors for poor outcomes by comparing the baseline characteristics and treatments performed by using the 6-month modified Rankin scale score. Poor outcomes were defined by an modified Rankin scale score of 3-6.ResultsA total of 162 patients were included. A total of 129 (79.6%) patients were treated by microsurgery, and 33 (20.4%) patients were treated by EVT. In multivariate analysis, factors associated with poor outcomes included hematoma volume, realization of a decompressive craniectomy, occurrence of procedure-related symptomatic cerebral ischemia, occurrence of delayed cerebral ischemia, and EVT. In the propensity score matching analysis (n = 33 per group), poor outcomes were observed in 30% of the patients in the clipping group versus 76% in the EVT group (P < 0.001). These differences may have been related to a longer delay between hospital admission and hematoma evacuation in the EVT group.ConclusionsIn the specific subgroup of ruptured MCAa with intracerebral hematoma that requires surgical evacuation, clipping with concomitant hematoma evacuation could provide better functional outcomes than EVT followed by surgical evacuation.© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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