J Korean Neurosurg Soc 52 | August 2012 the determining factor was the ICH location. However, Lee et al.9) reported that patients with ICH located on the temporal lobe showed a more favorable prognosis. Whereas Kim et al.8) reported that the same favorable result was observed from the patients with the ICH located in the sylvian fissure. Although results were not statistically significant, our study showed that those with ICH on the temporal lobe showed a better clinical prognosis. A midline shift on brain CT was another critical fac- tor to determine a patient’s prognosis due to its mass effect. When we set the cut-off value for a midline shift as 4.5 mm, 95.5% of patients had a favorable clinical outcome when the midline shift was less than 4.5 mm. However, when it was more than 4.5 mm, 42.1% patients showed a poor clinical outcome, although it comprised a relatively low percentage in the total population. In a similar manner, if we set the hematoma vol- ume fixed to 31 mL, specificity and sensitivity was the highest. If the hematoma volume was less than 31 mL, 91.7% of the pa- tients showed a better clinical outcome. However, if the hema- toma volume was more than 31 mL, a relatively small propor- tion of patients (41.2%) had unfavorable outcome. Therefore, it was expected that the patients with minimal hematoma volume showed a more favorable surgical outcome. Nevertheless, even if the patients had a larger volume of hematoma with a midline shift, this should not be an absolute criterion to determine a pa- tient’s prognosis to give up the surgical treatment. In summary, the less the residual hematoma volume, the better the patient prognosis, as the hemorrhage itself significantly influenced to cause cerebral edema, vasospasm, and multiple brain injury. This study also demonstrated that the patients with less residual hematoma volume showed a more favorable prognosis. Yet, it was obvious that the patients with minimal residual hematoma volume showed a less favorable prognosis than those without ICH. The surgical intervention definitely prevents the second- ary brain injury. Nonetheless, it is important to consider that initial brain injury was more critical in those with ICH than those without. CONCLUSION This study demonstrated that predictors of a good prognosis for ruptured MCA aneurysm were under 65 years old, had good initial mental status, a preoperative hematoma volume below 31 mL, and a midline shift of less than 4.5 mm. These predictors were important in determining the prognosis of surgical out- come. However, also important to note was that patients without good prognostic factors did not necessarily proceed to poor sur- gical outcome, as this probability was relatively low. 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