gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Ultra early decompressive craniectomy in aneurysmal intracerebral hemorrhage

Meeting Abstract

  • D. Jussen - Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin
  • S. Marticorena - Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin
  • P. Vajkoczy - Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin
  • P. Horn - Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.09.08

DOI: 10.3205/12dgnc242, URN: urn:nbn:de:0183-12dgnc2429

Published: June 4, 2012

© 2012 Jussen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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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.