gms | German Medical Science

68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
7. Joint Meeting mit der Britischen Gesellschaft für Neurochirurgie (SBNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

14. - 17. Mai 2017, Magdeburg

Decompressive craniectomy in patients suffering from spontaneous intracerebral hemorrhage: Influence of additional clot evacuation – a single-centre series

Meeting Abstract

  • Alexis Hadjiathanasiou - Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Patrick Schuss - Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Inja Ilic - Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Valeri Borger - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Hartmut Vatter - Rheinische Friedrich-Wilhelms-Universität, Neurochirurgische Klinik, Bonn, Deutschland
  • Erdem Güresir - Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.25.06

doi: 10.3205/17dgnc540, urn:nbn:de:0183-17dgnc5404

Veröffentlicht: 9. Juni 2017

© 2017 Hadjiathanasiou et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Decompressive craniectomy (DC) may be performed in patients with intractably elevated intracranial pressure due to intracerebral hemorrhage (ICH). However, the benefit of additional surgical clot evacuation is still controversially discussed. We therefore analyzed our institutional data.

Methods: Between 2007 and 2015, 31 patients suffering from spontaneous, hypertensive ICH underwent DC with and without clot evacuation in our institution. Patients were stratified into two groups: 1) patients with ICH who underwent DC without clot evacuation and 2) patients with ICH who underwent DC with additional clot evacuation. Patient characteristics, radiological features, postoperative complications, signs of cerebral herniation, and presence of antiplatelet or anticoagulant premedication were assessed and analyzed. Outcome was assessed according to the modified Rankin Scale (mRS) after 6 months and stratified into favourable (mRS 0-4) versus unfavourable (mRS 5-6).

Results: Overall, 10 patients (32%) achieved favourable outcome. 19 (61%) patients with ICH underwent DC without clot evacuation, whereas 12 (39%) patients underwent DC with clot evacuation. Mean ICH volume was similar in both groups (p=0.9). Functional outcome did not differ between both groups (p=0.4). Furthermore, reduction of initial midline shift after DC did not significantly differ in patients who underwent DC without, and patients who underwent DC with additional clot evacuation (p=0.8).

Conclusion: DC is safe and feasible in treating patients with intractably elevated intracranial pressure due to ICH. However, the present series showed no benefit of additional clot evacuation after DC for ICH. Therefore, ICH evacuation as an invasive and potentially dangerous procedure might not be necessary and should therefore be omitted according to the present study.