Decompressive Craniectomy with Hematoma Evacuation for Large Hemispheric Hypertensive Intracerebral Hemorrhage

Abstract

Hemispheric hypertensive intracerebral hemorrhage (ICH) has a high mortality rate. Decompressive craniectomy (DC) has generally been used for the treatment of severe traumatic brain injury, aneurysmal subarachnoid hemorrhage, and hemispheric cerebral infarction. However, the effect of DC on hemispheric hypertensive ICH is not well understood. To investigate the effects of DC for treating hemispheric hypertensive ICH, we retrospectively reviewed the clinical and radiological findings of 21 patients who underwent DC for hemispheric hypertensive ICH. Eleven of the patients were male and 10 were female, with an age range of 22-75 years (mean, 56.6 years). Their preoperative Glasgow Coma Scale scores ranged from 3 to 13 (mean, 6.9). The hematoma volumes ranged from 33.4 to 98.1 mL (mean, 74.2 mL), and the hematoma locations were the basal ganglia in 10 patients and the subcortex in 11 patients. Intraventricular extensions were observed in 11 patients. With regard to the complications after DC, postoperative hydrocephalus developed in ten patients, and meningitis was observed in three patients. Six patients had favorable outcomes and 15 had poor outcomes. The mortality rate was 10 %. A statistical analysis showed that the GCS score at admission was significantly higher in the favorable outcome group than that in the poor outcome group (P = 0.029). Our results suggest that DC with hematoma evacuation might be a useful surgical procedure for selected patients with large hemispheric hypertensive ICH.

Cranioplasty after decompressive craniectomy: is there a rationale for an initial artificial bone-substitute implant? A single-center experience after 631 procedures

“…Once the neurological and medical states of the patient have been stabilized, bone grafting is performed for esthetic, but also therapeutic, reasons and is associated with postoperative neurological improvement. 1,3,[7][8][9][11][12][13]16,22,24,27 Compared with other neurosurgical interventions, the complication rate of cranioplasty after decompressive craniectomy is surprisingly high, with a reoperation rate for wound infection, rebleeding, and wound-healing problems of up to 36.5%. 23,26 Long-term complications after autograft implantation have become an increasing concern in recent years.…”

Intracerebral Hemorrhage: A Common and Devastating Disease in Need of Better Treatment

“…Various groups have reported their experience of DHC with hematoma evacuation, though none in the context of a randomized trial 7,23,25,26,35,47,49 . The findings of these single-center studies suggest that DHC is feasible in large hemispheric ICH.…”

Regression models of interrelationships between clinical and neurobiological parameters in treatment of manic-delusional conditions in attack-like schizophrenia

“…У пациентов с благоприятным исходом забо-левания была правосторонняя локализация гема-томы, ее объем не превышал 90 мл, значения по ШКГ до операции были не менее 7 баллов. При консервативном лечении ПГ объемом более 60 мл летальность достигает 90% [26][27][28]. В одном иссле-довании удалось снизить летальность в 3,75 раза, однако пациентов с удовлетворительным функцио-нальным исходом было всего лишь 15%.…”