Artikel
Decompressive craniectomy in patients suffering from spontaneous intracerebral hemorrhage: Influence of additional clot evacuation – a single-centre series
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Veröffentlicht: | 9. Juni 2017 |
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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.