Decompressive Craniectomy with Hematoma Evacuation for Large Hemispheric Hypertensive Intracerebral Hemorrhage
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 infa
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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.
S. Takeuchi (*), K. Nagatani, N. Otani, H. Nawashiro, and K. Shima Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan e-mail: [email protected] Y. Takasato, H. Masaoka, T. Hayakawa, H. Yatsushige, and K. Shigeta Department of Neurosurgery, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014, Japan
Keywords Decompressive craniectomy hemorrhage • Hypertensive • Outcome
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Intracerebral
Introduction Hypertensive intracerebral hemorrhage (ICH) accounts for 10–20 % of strokes [2]. The reported 30-day mortality range is approximately 30–50 % [3, 6]. The International Surgical Trial in Intracerebral Haemorrhage (STICH) study, a landmark trial of over 1,000 ICH patients, showed that emergency surgical hematoma evacuation via craniotomy within 72 h of onset failed to improve the outcome compared with a policy of initial medical management [10]. However, patients with large ICH always experience progressive neurological deterioration or cerebral herniation, and this subgroup of patients has been excluded from most of the previous trials. Therefore, the results of such trials cannot be extrapolated to guide the treatment of rapidly deteriorating patients with ICH [13], and for now, the issue of what is the best treatment for patients with ICH remains controversial. Decompressive craniectomy (DC) is a surgical procedure performed to relieve the malignant elevation of intracranial pressure (ICP), and has been used f
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