Article
Decompressive hemicraniectomy after subarachnoid haemorrhage – justifiable in light of long-term outcome?
Dekompressive Hemikraniektomie nach Subarachnoidalblutung – Angesichts der Langzeitergebnisse gerechtfertigt?
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Authors
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Michael Veldeman
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Miriam Weiss
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Walid Albanna
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Catharina Conzen
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Tobias Philip Schmidt
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Henna Schulze-Steinen
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Hans Clusmann
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Gerrit Alexander Schubert
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Decompressive hemicraniectomy (DHC) is a potentially lifesaving procedure able to alleviate refractory intracranial hypertension and thus prevent death from uncal herniation. The spectrum of indications for this procedure is expanding and we present long-term results in a series of patients suffering from aneurysmal subarachnoid hemorrhage (aSAH). DHC for this indication remains controversial as refractory intracranial pressure is indicative of severe and diffuse cerebral damage. The goal of this analysis was to identify predictors of favorable outcome after DHC in aSAH patients.
Methods: All aSAH cases treated between 2010 and 2019 in a single institution were included. Patients additionally treated with decompressive hemicraniectomy due to refractory intracranial hypertension, were identified and the occurrence of DCI and DCI-related infarctions was noted alongside clinical outcome, assessed by means of the Glasgow outcome scale after 12 months. In the DHC subgroup the effect of patient- and disease specific aspects on long-term outcome were examined.
Results: Of 337 aSAH cases presented between 2010 and 2019, 64 (19.0%) were treated with DHC. In ten cases, DHC was performed during initial clip ligation (primary DHC). In the remainder of cases DHC was performed on average 4.0 ± 3.9 days after the initial hemorrhage (secondary DHC). Of all DHC treated patients, 12 month mortality was 32.8%, and only 9 (14.0%) cases reached favorable outcome. DHC was more commonly performed in younger patients (p = 0.002) with more severe aSAH according to Hunt & Hess (p < 0.001) and modified Fisher grading (p < 0.001). In multivariate analysis, only younger age (p = 0.017) but not the absence of DCI or DCI-related infarction nor milder aSAH severity, were associated with favorable outcome after DHC.
Conclusion: Decompressive hemicraniectomy, though lifesaving has only a limited probability of offering survival in a clinical favorable state. The decision to perform DHC has to be critically evaluated on an individual basis. We identified young age to be the sole independent predictor of favorable outcome after DHC in SAH patients.
