gms | German Medical Science

Objective: Decompressive craniectomy (DC) may become a life-saving measure for patients witch subarachnoid hemorrhage (SAH). However, optimal DC management is still the matter of debate. In this largest series of SAH patients with DC, we analyzed the impact of DC timing on functional outcome of SAH.

Method: 855 consecutive SAH patients treated at our clinic between January 2003 and April 2014 were included to this study. DC performed within 24 hours after ictus was defined as ultra-early DC.

Results: 218 patients (25.5%) underwent DC. Initial analysis could not reveal significant advantages of DC timing. However, further analysis with the exclusion of WFNS Grade 5 patients showed that ultra-early DC significantly decreased in-hospital mortality (p= 0.0444, OR=2.53), delayed cerebral infarction on computed tomography scans (p= 0.0156, OR=2.49) and unfavorable outcome at 6 months (defined as modified Rankin scale>3, p=0.0448, OR=2.18). Among survivals, ultra-early DC reduced the duration of hospital stay (p=0.0297). The need for DC was predicted by the following admission variables: WFNS (p<0.0001) and Fisher (p<0.0001) grades, severe intraventricular hemorrhage (>3point of the Graeb-score, p=0.0363, OR=1.49) and intracerebral hematoma (p<0.0001, regardless the treatment modality).

Conclusions: DC can significantly reduce the morbidity and mortality of SAH patients, especially when performed at the very early stage of disease and at the absence of the signs of severe early brain injury. Early consideration of DC predictors may be helpful in the optimization of DC timing and therefore in the improvement of SAH outcome.