Artikel
Decompressive craniectomy after subarachnoid haemorrhage – a systematic review and meta-analysis
Dekompressive Kraniektomien nach Subarachnoidalblutungen – ein systematisches Review und Meta-Analyse
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Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Decompressive craniectomy (DC) is a standard neurosurgical procedure against intractable intracranial hypertension. Patients with severe aneurysmal subarachnoid hemorrhage (SAH) are prone to intracranial hypertension, necessitating DC in certain cases. However, the clinical utility of DC after SAH remains unclear. Hereby we present the first systematic review and meta-analysis summarizing the published studies on DC in SAH patients.
Methods: We systematically searched PubMed, Scopus, Web of Science and Cochrane Library for articles published before Jul 10, 2019 reporting on rates, indications, timing, complications and outcome of SAH patients undergoing DC. The quality of the included studies was analyzed according to the Newcastle-Ottawa Scale (NOS).
Results: Of 1085 identified unique records, 29 retrospective studies published between 1993 and 2018 were included to the final analysis. The data of 1.175 DC performed in the pooled cohort of 7.228 SAH patients was analyzed. In overall, the studies were characterized with low to moderate study quality, predominantly reporting on certain subgroups of DC patients with limited or no data regarding the non-DC cases. The mean DC rate was 12% (range 1.5% – 39.5%), whereat the majority of DC (57.7%) were performed secondarily. Younger age (54.5 vs 58.5 years), poor initial clinical condition (H&H/WFNS=4-5: 84.3% vs 19%), higher severity of SAH (o/mFS=3-4: 91.1% vs 25%), treatment modality (clipping) were associated with the indication to and the timing of DC. Functional outcome after primary DC was superior to secondary DC (mortality: 22.6% vs 47.9%, unfavorable outcome: 60.6% vs 81%).
Conclusion: Due to substantial heterogeneity and incompleteness of the reported data, the current evidence on DC after SAH remains very sparse. We recommend the initiation of a prospective multi-centric register for proper evaluation of the clinical value of DC in SAH patients.