Secondary insults and outcomes in patients with hypertensive basal ganglia hemorrhage

Fei, Z.; Zhang, X.; Song, Shuwei

doi:10.1007/3-211-32318-x_54

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…15,36 Rather counterintuitively, surgical clot evacuation may in some cases also contribute to ICP elevation, as it bears the potential to induce edema formation through tissue manipulation and/or venous interruption. 10,11,20,21,25,32 Although the topic of clot evacuation in ICH has gained increased attention in recent years 4,21,27 following a relatively silent period after the 1961 landmark paper by McKissock et al, 26 the role of decompressive craniectomy in large ICHs has only scarcely been explored. The majority of the reports on decompressive craniectomy following ICH involve a combination of decompression with concurrent clot evacuation.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

Heuts

Bruce

Zacharia

et al. 2013

FOC

View full text Add to dashboard Cite

show abstract

“…8,17 Rather counter intuitively, surgical clot evacuation may in some cases also contribute to ICP elevation, as it bears the potential to induce edema formation through tissue manipulation and/or venous interruption. 5,10 Although the topic of clot evacuation in ICH has gained increased attention in recent years 11,14 following a relatively silent period after the 1961 landmark paper by McKissock et al, 13 the role of decompressive craniectomy in large ICHs has only scarcely been explored. The majority of the reports on decompressive craniectomy following ICH involve a combination of decompression with concurrent clot evacuation.…”

Section: Discussionmentioning

confidence: 99%

Decompressive Hemicraniectomy in Hypertensive Basal Ganglia Hemorrhages

Joarder¹,

Karim

Sujon³

et al. 2016

PULSE

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Objectives: The aim of this study was to analyze efficacy and safety of decompressive hemicraniectomy (DHC) in hypertensive basal ganglia hemorrhage (HBGH). Neurosurgical management of HBGH is still a controversial issue. Surgical techniques are diverse, from the open large craniotomy, to the minimally invasive techniques like stereotactic aspiration of the HBGH, endoscopic evacuation and stereotactic catheter drainage after instillation of thrombolytic agents. Decompressive hemicraniectomy lowers intracranial pressure and improves outcome in patients with HBGH. Methods: 8 patients with HBGH who underwent decompressive craniectomy in the last 2 years were analyzed. Parameters investigated included clinical presentations, radiologic profile, time interval from ictus to surgery, and modified Rankin Scale score at 6 months. Results: The patients mean age 55 years, the mean Glasgow Coma Scale (GCS) score was 7 (range 5-13), the mean ICH volume was 58 ml (range 40-70 ml), and the mean midline shift was 10.62 mm (range 6-16 mm). The outcome after 6 months was appreciated as good (modified Rankin Scale 0-4) or poor (modified Rankin Scale 5-6). Five patients had good and three had poor outcomes (including two deaths). Conclusion: We conclude, based on this small cohort, that DC can reduce mortality in some cases. Larger prospective studies are needed to assess safety and efficacy of this method.

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“…Thus ICP increases again and reaches pathological values a few hours after removal of the hematoma. 14,15 To resolve this problem, decompressive craniectomy may be a choice. This surgical technique allows the edematous tissue expansion away from the lateral ventricle, the diencephalons, and the mesencephalon.…”

Section: Discussionmentioning

confidence: 99%

Decompressive Craniectomy in Addition to Hematoma Evacuation Improves Mortality of Patients with Spontaneous Basal Ganglia Hemorrhage

Liu

Huang

et al. 2010

Journal of Stroke and Cerebrovascular Diseases

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Secondary insults and outcomes in patients with hypertensive basal ganglia hemorrhage

Cited by 6 publications

References 7 publications

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

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

Decompressive Hemicraniectomy in Hypertensive Basal Ganglia Hemorrhages

Decompressive Craniectomy in Addition to Hematoma Evacuation Improves Mortality of Patients with Spontaneous Basal Ganglia Hemorrhage

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