Decompressive craniectomy in subarachnoid hemorrhage

Güresir, Erdem; Schuss, Patrick; Vatter, Hartmut; Raabe, Andreas; Seifert, Volker; Beck, Jürgen (2009). Decompressive craniectomy in subarachnoid hemorrhage. Neurosurgical focus, 26(6), E4. Charlottesville, Va.: American Association of Neurological Surgeons 10.3171/2009.3.FOCUS0954

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OBJECT: The aim of this study was to analyze decompressive craniectomy (DC) in the setting of subarachnoid hemorrhage (SAH) with bleeding, infarction, or brain swelling as the underlying pathology in a large cohort of consecutive patients. METHODS: Decompressive craniectomy was performed in 79 of 939 patients with SAH. Patients were stratified according to the indication for DC: 1) primary brain swelling without or 2) with additional intracerebral hematoma, 3) secondary brain swelling without rebleeding or infarcts, and 4) secondary brain swelling with infarcts or 5) with rebleeding. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months (mRS Score 0-3 favorable vs 4-6 unfavorable). RESULTS: Overall, 61 (77.2%) of 79 patients who did and 292 (34%) of the 860 patients who did not undergo DC had a poor clinical grade on admission (World Federation of Neurosurgical Societies Grade IV-V, p < 0.0001). A favorable outcome was attained in 21 (26.6%) of 79 patients who had undergone DC. In a comparison of favorable outcomes in patients with primary (28.0%) or secondary DC (25.5%), no difference could be found (p = 0.8). Subgroup analysis with respect to the underlying indication for DC (brain swelling vs bleeding vs infarction) revealed no difference in the rate of favorable outcomes. On multivariate analysis, acute hydrocephalus (p = 0.009) and clinical signs of herniation (p = 0.02) were significantly associated with an unfavorable outcome. CONCLUSIONS: Based on the data in this study the authors concluded that primary as well as secondary craniectomy might be warranted, regardless of the underlying etiology (hemorrhage, infarction, or brain swelling) and admission clinical grade of the patient. The time from the onset of intractable intracranial pressure to DC seems to be crucial for a favorable outcome, even when a DC is performed late in the disease course after SAH.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Raabe, Andreas and Beck, Jürgen

ISSN:

1092-0684

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:13

Last Modified:

06 Dec 2013 13:59

Publisher DOI:

10.3171/2009.3.FOCUS0954

PubMed ID:

19485717

Web of Science ID:

000266501400004

URI:

https://boris.unibe.ch/id/eprint/32030 (FactScience: 196860)

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