Decompressive Craniectomy With Clot Evacuation in Large Hemispheric Hypertensive Intracerebral Hemorrhage

“…10,24,25,30 We present a preliminary series of 5 cases in which clot evacuation was not attempted due to the fact that all clots were deep and in the dominant hemisphere. We hope these data will help isolate the effect of DHC without clot evacuation.…”

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confidence: 99%

Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Heuts

Bruce

Zacharia

et al. 2013

FOC

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Object Large intracerebral hemorrhage (ICH), compounded by perihematomal edema, can produce severe elevations of intracranial pressure (ICP). Decompressive hemicraniectomy (DHC) with or without clot evacuation has been considered a part of the armamentarium of treatment options for these patients. The authors sought to assess the preliminary utility of DHC without evacuation for ICH in patients with supratentorial, dominant-sided lesions. Methods From September 2009 to May 2012, patients with ICH who were admitted to the neurological ICU at Columbia University Medical Center were prospectively enrolled in that institution's ICH Outcomes Project (ICHOP). Five patients with spontaneous supratentorial dominant-sided ICH underwent DHC without clot evacuation for recalcitrant elevated ICP. Data pertaining to the patients' characteristics and outcomes of treatment were prospectively collected. Results The patients' median age was 43 years (range 30–55 years) and the ICH etiology was hypertension in 4 of 5 patients, and systemic lupus erythematosus vasculitis in 1 patient. On admission, the median Glasgow Coma Scale (GCS) score was 7 (range 5–9). The median ICH volume was 53 cm3 (range 28–79 cm3), and the median midline shift was 7.6 mm (range 3.0–11.3 mm). One day after surgery, the median decrease in midline shift was 2.7 mm (range 1.5–4.6 mm), and the median change in GCS score was +1 (range −3 to +5). At discharge, all patients were still alive, and the median GCS score was 10 (range 9–11), the median modified Rankin Scale (mRS) score was 5 (range 5–5), and the median NIHSS (National Institutes of Health Stroke Scale) score was 22 (range 17–27). Six months after hemorrhage, 1 patient had died, 2 were functionally dependent (mRS Score 4–5), and 2 were functionally independent (mRS Score 0–3). Outcomes for the patients treated with DHC were good compared with 1) outcomes for all patients with spontaneous supratentorial ICH admitted during the same period (n = 144) and 2) outcomes for matched patients (dominant ICH, GCS Score 5–9, ICH volume 28–79 cm3, age < 60 years) whose cases were managed nonoperatively (n = 5). Conclusions Decompressive hemicraniectomy without clot evacuation appears feasible in patients with large ICH and deserves further investigation, preferably in a randomized controlled setting.

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“…The ICH was lobar in 3 patients and basal ganglia in 26 patients. On admission, the mean GCS score was 8 (range [5][6][7][8][9][10][11][12][13], and the mean ICH volume was 55 ml (range 42-82 ml), the mean midline shift was 10 mm (range 8-16 mm). …”

Section: Original Articlementioning

confidence: 99%

“…Of the few published reports on DHC in intracerebral hemorrhage (ICH), most of the reports focus on a combined treatment of hematoma evacuation plus DHC. [5][6][7][8][9] Reports on DHC as the only treatment for ICH are rare, and the surgical decompression in these cases was smaller than a standardized DHC. 10 The rationale for evacuation of ICH is to prevent the toxic effects of hematoma degradation and the mechanical complication of mass effect.…”

Section: Introductionmentioning

confidence: 98%

Retrospective comparison of decompressive hemicraniectomy and hematoma evacuation for spontaneous supratentorial intracerebral hematoma

Joarder

Karim

Kamal³

et al. 2015

PULSE

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Objectives: The aim of this study was to test the hypothesis that decompressive hemicraniectomy (DHC), compared with craniotomy with evacuation of hematoma, and would improve clinical outcomes of patients with supratentorial intracerebral hemorrhage (SICH). Methods: We compared patients (November 2008-February 2014 with supratentorial ICH treated with DHC without hematoma evacuation and craniotomy with hematoma evacuation. DHC measured at least 150 mm and included opening of the dura. We analyzed clinical, radiological, and surgical characteristics. Outcome at 6 months was divided into good (modified Rankin Scale 0-4) and poor (modified Rankin Scale 5-6). Results: Fifteen patients (mean age 58 years) with ICH were treated by DHC. Median hematoma volume was 61 ml and mean preoperative Glasgow Coma Scale (GCS) was 7. Ten patients had good and five had poor outcomes. In hematoma evacuation group 29 patients were treated. Median hematoma volume was 55 ml and mean preoperative Glasgow Coma Scale (GCS) was 8. Seventeen patients had good and twelve had poor outcomes. Conclusions: DHC is more effective than hematoma evacuation in patients with SICH. Based on this small cohort, DHC may reduce mortality. Larger prospective study is warranted to assess safety and efficacy.

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Decompressive Craniectomy With Clot Evacuation in Large Hemispheric Hypertensive Intracerebral Hemorrhage

Abstract: Decompressive hemicraniectomy with hematoma evacuation is life-saving and improves unfavorable outcomes in a select group of young patients with large right hemispherical ICH.

Cited by 101 publications

References 32 publications

Novel therapies for intracerebral hemorrhage

Novel therapies for intracerebral hemorrhage

Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Retrospective comparison of decompressive hemicraniectomy and hematoma evacuation for spontaneous supratentorial intracerebral hematoma

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