• Hidetoshi Matsukawa, Takanori Miyazaki, Katsunari Kiko, Hiroyasu Kamiyama, Nakao Ota, Kosumo Noda, Osamu Takahashi, Takaharu Shonai, Takashi Fujisawa, Sadahisa Tokuda, and Rokuya Tanikawa.
• Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
• World Neurosurg. 2019 May 1; 125: e612-e619.

ObjectiveSylvian subpial hematoma (SSH) is occasionally observed in aneurysm subarachnoid hemorrhage (aSAH) when accompanied with the thick clot in the inferior limiting sulcus (ILS). We aimed to determine whether the thickness of the clot in the ILS (TCILS) was an indicator of SSH.MethodsData from 150 consecutive patients with aSAH were retrospectively analyzed. The relationship between TCILS on axial computed tomography (CT) image and intraoperatively confirmed SSH was reviewed. In patients without SSH, the average of the clot thickness in the bilateral ILS was used. The primary outcome was SSH.ResultsThe median TCILS of the SSH group (n = 18, 12%) was larger than that of the non-SSH group (n = 132, 88%) (21 vs. 2.1 mm, respectively; P < 0.001). The intraclass correlation coefficients for clot thickness in the right and left ILS between 2 observers were 0.97 (P < 0.001) and 0.85 (P < 0.001). The TCILS threshold of ≥6.0 mm was associated with SSH, with a sensitivity of 89% and specificity of 99%. The unadjusted and adjusted odds ratios of the SSH of clot thickness in the affected ILS ≥6 mm relative to clot thickness in the affected ILS <6 mm were 263 (95% confidence interval [CI], 46-5063) and 137 (95% CI, 19-3029), respectively.ConclusionsThe clot thickness in the ILS on CT image was easily measured and could be a marker of SSH. SSH assessment could be useful in helping us predict the clinical course in patients with aSAH.Copyright © 2019 Elsevier Inc. All rights reserved.

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