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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Primary decompressive craniectomy in patients with space-occupying sylvian haematoma due to aneurysmal subarachnoid haemorrhage

Primäre dekompressive Kraniektomie bei Patienten mit raumforderndem sylvischem Hämatom aufgrund einer aneurysmatischen Subarachnoidalblutung

Meeting Abstract

  • presenting/speaker Fabian Wenz - Universitätsklinikum Mannheim, Klinik für Neurochirurgie, Mannheim, Deutschland
  • Katharina Hackenberg - Universitätsklinikum Mannheim, Klinik für Neurochirurgie, Mannheim, Deutschland
  • Andreas Ziebart - Universitätsklinikum Mannheim, Klinik für Neurochirurgie, Mannheim, Deutschland
  • Daniel Hänggi - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Nima Etminan - Universitätsklinikum Mannheim, Klinik für Neurochirurgie, Mannheim, Deutschland
  • Amr Abdulazim - Universitätsklinikum Mannheim, Klinik für Neurochirurgie, Mannheim, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV020

doi: 10.3205/20dgnc025, urn:nbn:de:0183-20dgnc0253

Veröffentlicht: 26. Juni 2020

© 2020 Wenz 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) is commonly performed for the management of increased intracranial pressure, especially in patients after malignant cerebral infarction or traumatic brain injury. In patients with aneurysmal subarachnoid haemorrhage (SAH) and space-occupying sylvian haematomas early DC may be considered during surgical treatment of ruptured intracranial aneurysm with the intention to improve local perfusion and thereby limit secondary brain injury. We investigated the efficacy of primary DC with respect to functional outcome as well as the occurrence of delayed cerebral ischemia (DCI) and angiographic vasospasm.

Methods: Between 2010 and 2019, 501 consecutive SAH patients were admitted to our hospital. We identified 44 patients with SAH and space-occupying sylvian haematomas with at least 20ml of clot volume and/or 5mm of resulting midline-shift. 26 patients received primary DC with clipping and haematoma evacuation (cohort I), while 18 patients received clipping and haematoma evacuation only (cohort II). The two groups were compared with respect to functional outcome at 3 months using dichotomized extended Glasgow Outcome Scale (eGOS 1-5: unfavourable and eGOS 6-8: favourable). Additionally, we evaluated the rate of clinical DCI, angiographic vasospasms, DCI-related infarctions and secondary DC.

Results: Despite generally comparable baseline characteristics, cohort I tended to have larger clot volumes and higher rates of midline shifts (Table 1 [Tab. 1]). There was no statistically significant effect of primary DC on good functional outcome at 3 months (23.1% vs. 16.7%; OR: 1.50 [0.32-6.99]). Furthermore, the incidence of clinical DCI (aOR: 0.85 [0.21-3.45]) as well as angiographic vasospasm (aOR: 0.79 [0.22-2.88]) did not differ significantly in cohort I. However, the rate of DCI-related infarctions in cohort I was significantly lower (15.4% vs 47.1%; OR: 0.20 [0.05-0.85]), which was even more evident after adjustment for patient age, WFNS grade, midline shift and clot volume (OR:0.09 [0.01-0.64]). Notably 33.3% of patients of cohort II received secondary DC due to increasing brain swelling or infarction, of which 80% were performed within 96 hours after aneurysm treatment.

Conclusion: Our data highlight that primary DC in patients with SAH and space-occupying haematoma may be associated with a reduced rate of DCI-associated infarctions. However, large patient samples are required to investigate the effect of early DC in this specific subset of SAH patients on functional outcome.

Table 1 [Tab. 1]

Table 2 [Tab. 2]