Cerebral hernia induced by intracerebral hematoma in patients with poor-grade ruptured intracranial aneurysm: emergent surgical treatment without angiography

Cerebral hernia induced by intracranial haematoma in patients with poor-grade ruptured intracranial aneurysm is a severe disease, which is associated with high mortality rates. This study aims to discuss the treatment principle of cerebral hernia caused by intracranial haematoma due to ruptured intracranial aneurysms-without preoperative angiography. 17 patients of cerebral hernia induced by aneurysmal ICH were treated microsurgically in our department. For serious clinical conditions, all patients received emergent surgical without preoperative angiography. The intracranial aneurysm clipping was successfully completed in 17 cases; direct clipping of the aneurysmal necks was achieved in 7 patients, while reconstructive clipping was performed in 10 patients. 4 cases with Hunt-Hess grade VI-V died after operation, 13 cases were survived, 3 of which had communicating hydrocephalus and were cured by ventriculo-peritoneal shunt. At follow-up, 6 of 13 survivors had favorable outcome (ADL grade I 3; ADL grade II 3), 5 patients had mild disability (ADL grade III), and the rest had severe disability (ADL grade IV). No impaired cognition observed in the survived patients. In patients with poor neurological grade at admission, whose consciousness rapidly deteriorated, because of aneurysmal ICH, urgent ICH removal and aneurysm clipping without the delay for diagnostic angiography may be life saving and a satisfactory outcome can be accomplished.