gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Factors determining outcome following decompressive craniectomy for ischemic stroke, traumatic brain injury and subarachnoid hemorrhage

Einflussfaktoren auf das Outcome nach dekompressiver Kraniektomie aufgrund von malignem ischämischen Schlaganfall, Schädel-Hirn-Trauma und Subarachnoidalblutung

Meeting Abstract

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  • corresponding author T. Scholz - Neurochirurgische Universitätsklinik Bonn
  • F. Daher - Neurochirurgische Universitätsklinik Bonn
  • C. Schaller - Neurochirurgische Universitätsklinik Bonn

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.01.06

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

Published: April 11, 2007

© 2007 Scholz 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: In the course of malignant ischemic stroke (IS), traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH), the intracranial pressure (ICP) can increase dramatically. As a last desperate solution, neurosurgery can offer decompressive craniectomy (DC). However, factors influencing the functional outcome are still being discussed controversly. We attempted to identify clinical predictors in terms of survival and functional outcome.

Methods: In retrospect we analysed n=100 patients aged from 2 months - 72 years (mean=49), who had undergone DC for IS (n=57), TBI (n=22) and SAH (n=21). Functional outcome was assessed using the Glasgow Outcome Sale (GOS). The different entities (IS, TBI, SAH) were statistically compared using nonparametric tests to identify individual influencing factors. GCS-value at time of indication, age, level of ICP, duration of symptoms and hemispheric localisation were analyzed in detail. The level of significance was set at p<0,05.

Results: SAH-patients showed a significantly worse outcome when compared to patients with IS after a mean of 9 months. A GCS-value lower than 6 at the time of indication for DC is associated with a significantly worse outcome. Age, level and duration of elevated ICP did not significantly influence the outcome. There was no evidence that hemispheric dominance of the affected side influences functional outcome.

Conclusions: Patients with a monohemispheric lesion like IS are more likely to benefit from DC than patients with multifocal lesions due to vasospasm after SAH. The condition of the patient at the time of indication for DC as assessed by GCS determines the outcome. Age, duration of ICP elevation or lateralization of the lesion do not influence outcome. This is contrary to current publications of the American Heart Association concerning DC.