gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Value of decompressive craniectomy after severe aneurysmal subarachnoid hemorrhage

Nutzen der Dekompressionskraniektomie nach schwerer aneurysmatischer Subarachnoidalblutung

Meeting Abstract

  • corresponding author M. Jaeger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Leipzig
  • M. Schuhmann - Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Leipzig
  • C. Renner - Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Leipzig
  • J. Meixensberger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Leipzig

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.05.08

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Jaeger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The use of decompressive craniectomy in the treatment of elevated intracranial pressure (ICP) after aneurysmal subarachnoid hemorrhage (SAH) has not been extensively studied and the previously published results are inconsistent. Thus, the aim of our study was to assess clinical outcome after surgical decompression in patients suffering from SAH.

Methods: From 04/2001 to 04/2005 211 patients with spontaneous non-traumatic SAH were treated at our institution. In 17 of these patients a decompressive craniectomy was performed as a last step in the treatment of elevated ICP>25 mmHg (median WFNS-grade=4, median Fisher-grade=3). The reasons for raised ICP were space-occupying vasospastic infarctions (n=9) and diffuse brain edema (n=8). Outcome was assessed at 6 months after SAH (extended Glasgow Outcome Scale, eGOS). Patients with elevated ICP because of cerebral infarctions due to clip stenosis, coil dislocation or intracerebral hemorrhage were not included in this study.

Results: Outcome of the investigated patients after 6 months was poor: 9 patients died (eGOS 1), 7 patients remained in a persistent vegetative state (eGOS 2), and 1 patient was severely disabled (eGOS 3).

Conclusions: Based on the results of this study, the use of decompressive craniectomy in the treatment of patients with elevated ICP after SAH appears questionable. The severe primary hemorrhage-induced brain damage and the vasospasm-induced secondary brain damage seem to outweigh the positive pathophysiological effects of the surgical decompression on the cerebral circulation. However, the number of patients studied is too small to generally reject this potentially life-saving procedure, but one has to keep in mind that it appears unlikely to shift patients towards a favourable outcome.