Decompressive hemicraniectomy in the management of subcortical spontaneous intracerebral hemorrhage

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

“…In patients with supratentorial ICH who are in a coma, have large hematomas with significant midline shift, or have elevated ICP refractory to medical management, decompressive craniectomy with or without hematoma evacuation may be considered to reduce mortality. [453][454][455][456][457][458][459][460] 2b C-LD 2. In patients with supratentorial ICH who are in a coma, have large hematomas with significant midline shift, or have elevated ICP refractory to medical management, effectiveness of decompressive craniectomy with or without hematoma evacuation to improve functional outcomes is uncertain.…”

“…Therefore, decompressive craniectomy is often considered as a lifesaving procedure despite a lack of strong randomized evidence. This guideline is based primarily on data from small RCTs, 458,462 retrospective ser ies, [453][454][455][456][457]461,[463][464][465][466][467][468][469][470][471] a systematic review, 459 and a metaanalysis. 460 These studies compared decompressive craniectomy with medical management or craniotomy with clot evacuation.…”

“…Overall, the studies suggest that surgery may improve mortality compared with medical management. [453][454][455][456][457]470 Both a meta-analysis and a systematic review suggest that decompressive craniectomy may offer mortality benefits in the setting of supratentorial ICH. 459,460 Studies included in these analyses compare decompressive craniectomy with both medical management and craniotomy with clot evacuation.…”