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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

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Decompressive craniectomy after aneurysmal subarachnoid haemorrhage – a risk score for early prediction

Dekompressive Kraniektomie nach aneurysmatischer Subarachnoidalblutung – Risiko-Score für frühe Vorhersage

Meeting Abstract

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  • presenting/speaker Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland; Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Roland Rölz - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Daniela Pierscianek - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Mukesch Johannes Shah - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Karsten Henning Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Jürgen Beck - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, 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. DocP105

doi: 10.3205/20dgnc391, urn:nbn:de:0183-20dgnc3919

Veröffentlicht: 26. Juni 2020

© 2020 Jabbarli 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: The prognosis of patients with aneurysmal subarachnoid hemorrhage (SAH) requiring decompressive craniectomy (DC) is usually poor. Proper selection and early performing of DC might improve the patients’ outcome. We aimed at developing a risk score for the prediction of DC after SAH.

Methods: All consecutive SAH cases treated at the University Hospital of Essen between January 2003 and June 2016 (test cohort) and the University Hospital of Freiburg between January 2005 and December 2012 (validation cohort) were eligible for this study. Various parameters collected within 72 hours after SAH were evaluated through univariate and multivariate analyses to predict separately primary (PrimDC) and secondary DC (SecDC).

Results: The final analysis included 1376 patients. The constructed risk score included the following parameters: intracerebral ("Parenchymal") hemorrhage (1 point), "Rapid" vasospasm on angiography (1 point), Early cerebral infarction (1 point), aneurysm Sack > 5 mm (1 point), clipping ("Surgery", 1 point), age Under 55 years (2 points), Hunt&Hess grade≥4 ("Reduced consciousness", 1 point) and External ventricular drain (1 point). The PRESSURE score (0-9 points) showed high diagnostic accuracy for the prediction of PrimDC and SecDC in the test (AUC=0.842/0.818) and validation cohorts (AUC=0.903/0.823) respectively. 63.7% of the patients scoring ≥6points required DC (vs. 12% for the PRESSURE<6 points, p<0.0001). In the subgroup of the patients with the PRESSURE≥6points and absence of dilated/fixed pupils, PrimDC within 24 hours after SAH was independently associated with a lower risk of an unfavorable outcome (modified Rankin Scale >3 at 6 months), than in individuals with later or no DC (p=0.02).

Conclusion: Our risk score was successfully validated as a reliable predictor of DC after SAH. The PRESSURE score might present a background for a prospective randomized clinical trial addressing the utility of early prophylactic DC in SAH.