Predictive outcome factors in the treatment of subarachnoid hemorrhage with hematoma caused by ruptured anterior circulation aneurysms: A monocentric experience

Abstract

Introduction

Intracranial aneurysm (IA) rupture accounts for 3% of strokes and is associated with a concerning mortality rate. Subarachnoid hemorrhage with cerebral hematoma (CSAH) often results in a higher mortality rate; however, the optimal treatment approach remains unclear. This study aims to identify factors predicting poor outcomes and mortality in cases of CSAH due to ruptured aneurysms in the anterior cerebral circulation.

Methods

This study retrospectively included 102 patients with anterior circulation aneurysm ruptures, treated between 2017 and 2019. A multidisciplinary team determined the treatment strategies. Statistical analyses were performed to assess outcomes.

Results

In the bivariate analysis of CSAH related to anterior circulation aneurysm rupture, significant factors associated with morbidity (mRS >2 at one year follow-up) and mortality were: WFNS score severity, mydriasis, Tako-Tsubo, and the presence of hydrocephalus. In the multivariate analysis, significant factors for mortality were hydrocephalus (p < 0.01) and Tako-Tsubo (p < 0.001), while significant factors for morbidity were hydrocephalus (p < 0.01) and hematoma volume (p = 0.012).

Conclusion

Our study analyzed a series of cases involving CSAH from anterior circulation aneurysms. We emphasize the importance of prompt treatment for hydrocephalus and suggest that the diagnosis of Tako-Tsubo should delay but not prevent treatment. Depending on local ethical standards, treatment abstention could be considered in patients with severe WFNS scores, the presence of mydriasis, hematoma >45 mL, and hydrocephalus. Our findings indicate that life-threatening hematomas are best managed surgically, while smaller, non-life-threatening cases may benefit from endovascular treatment, though further randomized trials are needed for validation.