Decompressive craniectomy and expansive duraplasty with evacuation of hypertensive intracerebral hematoma, a randomized controlled trial

Abstract

Hypertensive intracerebral hemorrhage (ICH) has high morbidity and mortality rates. Decompressive craniectomy (DC) is generally used for the treatment of cases associated with refractory increased intracranial pressure (ICP). In this study, we investigated the beneficial effects of adding DC and expansive duraplasty (ED) to hematoma evacuation in patients who underwent surgery for large hypertensive ICH. A prospective randomized controlled clinical trial where 40 patients diagnosed having large hypertensive ICH was randomly allocated to either group A or B, each comprised 20 patients. Group A patients, the treatment group, were submitted to hematoma evacuation together with DC and ED, whereas group B patients, the control group, were submitted only to hematoma evacuation. Twenty-three (57.5 %) of the patients were males, with an overall age range of 34-79 years (mean 59.3 years). Preoperative Glasgow Coma Scale (GCS) scores in group A ranged from 4 to 13 (mean 7.1), while in group B it ranged from 4 to 12 (mean 6.8). Postoperative hydrocephalus occurred in 3 (15 %) patients in group A and in 4 (20 %) patients in group B, whereas meningitis occurred in one patient (5 %) in group A. The mortality rate was 2 (10 %) patients in group A as compared to 5 (25 %) patients in group B (p = 0.407). High admission GCS (p = 0.0032), younger age (p = 0.0023), smaller hematoma volume (p = 0.044), subcortical hematoma location (p = 0.041), absent or minimal preoperative (p = 0.0068), and postoperative (p = 0.0031) midline shift as well as absent intraventricular extension of the hematoma (p = 0.036) contributed significantly to a better outcome. Selected patients' subgroups who benefited from adding DC and ED to ICH evacuation were age category of 30 to less than 50 (p = 0.0015) and from 50 to less than 70 (p = 0.00619) as well as immediate preoperative GCS from 6 to 8 (p = 0.000436) and from 9 to 12 (p = 0.00774). At 6 months' follow-up, 14 (70 %) patients of group A had favorable outcome as compared to 4 (20 %) patients of group B (p = 0.0015). Adding DC with ED to evacuation of a large hypertensive hemispheric ICH might improve the outcome in selected group of patients.

Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery: A Retrospective Observational Study

“…Decompressive craniectomy carries a significant risk of rebleeding postoperatively (usually contralateral to the craniectomy site) and our findings (incidence of 7.9%) support the data reported so far. [38][39][40][41][42] The relatively high incidence of POH (3.6%) after cranioplasty in this series is also in line with the rates from the literature; POH as a complication occurs after up to 6.9% of cranioplasties. [43][44][45][46][47][48][49] Regarding bypass surgery, it has also been reported previously that ICH after vascular reconstruction surgery (as a result of moyamoya disease) occurs in 2.8% of cases, 50 which is comparable to the detected rate of 1.7% in our series.…”

Early Neurological Deterioration after Recanalization Treatment in Patients with Acute Ischemic Stroke

“…[ 25 ] Evacuation of a large hematoma could be life-saving for sICH. [ 26 ] Hypothermia may reduce CE and improve clinical outcomes. [ 27 ] In addition, intraventricular drainage of cerebral spinal fluid could help to resolve secondary hydrocephalus.…”

Recommended algorithms for surgical treatment of non-traumatic intracerebral haematoma

“…Альтернативой локального ВЖФ при ВЖК является эндоскопическое удаление ВЖК в сочетании с НВД [115][116][117][118] [6,31,32,[137][138][139][140][141][142][143][144]. Область применения этих операций расширяется.…”

“…В такой ситуации можно успешно применить широкую декомпрессивную краниоэктомию с сохранением костного лоскута до редукции симптомов отека мозга с последующей реимплантацией (см. Разгрузочные операции) [6,31,32].…”