Artikel
Ultra early decompressive craniectomy in aneurysmal intracerebral hemorrhage
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Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Intracerebral hematoma is a rare form of presentation of aneurysmal rupture. Most often the origin is a MCA-aneurysm. Historical data describe mortality rates of more than 50% among these patients. The aim of the study is to analyze whether decompressive craniectomy can improve outcome in aneurysmal intracerebral hemorrhage.
Methods: We performed a retrospective analysis of patients with aneurysmal intracerebral hemorrhage admitted between 06/08 and 05/11, which were treated via decompressive craniectomy. We analyzed GCS, Hunt & Hess grade, blood volume, timing of craniectomy and performed a comparison to previous data.
Results: We analyzed 18 consecutive patients, 13 with MCA-aneurysm and 5 with ACOM-aneurysm. A six months follow-up could be obtained in 56%. According to Hunt & Hess grading we included 1 patient with grade III, 4 patients with grade IV and 10 patients with grade V hemorrhage. Mean GCS on admission was 5.6 ± 1.1 pts. 15 patients were treated via primary craniectomy and 3 patients via secondary craniectomy. There was no significant difference in GCS between groups. 10 patients were treated for vasospasm. Mean GCS on discharge was 10 ± 0.8 pts. (n = 18). Mean GCS follow-up after 6 months was 14 ± 0.9 (n = 10). There is a statistically significant improve in GCS (P < 0.05). Overall mortality rate was 6%.
Conclusions: Compared to previous data with aneurysmal intracerebral hemorrhage there is a significantly improved survival and outcome. Despite poor clinical status on admission the majority of the patients made a good recovery. We therefore present early decompressive craniectomy as a valid option to treat patients with intracerebral mass lesion in aneurysmal hemorrhage.