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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Secondary decompressive craniectomy for vasospasm related infarction following aneurysmal subarachnoid haemorrhage – the influence of the size of infarction

Sekundäre dekompressive Kraniektomie bei vasospastischen Infarkten nach aneurysmatischer Subarachnoidalblutung – der Einfluss der Infarktgröße

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  • presenting/speaker Simon Brandecker - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Alexis Hadjiathanasiou - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Lorena Schenk - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Tim Lampmann - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Patrick Schuss - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Hartmut Vatter - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Erdem Güresir - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP191

doi: 10.3205/21dgnc472, urn:nbn:de:0183-21dgnc4725

Published: June 4, 2021

© 2021 Brandecker et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Aim of this study was to analyze the effect of secondary decompressive craniectomy (DC) on clinical outcome in patients with vasospasm related infarction following aneurysmal subarachnoid hemorrhage (aSAH) – regarding the influence of the size of infarction.

Methods: Between 01/2011 and 12/2019 28 consecutive patients with aSAH and vasospasm related infarctions underwent a decompressive craniectomy at our institution. Information including patient characteristics and outcome were prospectively collected in a computerized database. The size of infarction was measured by 19 segments, in which the territories of the major cerebral arteries were divided into. In addition, volumetric analysis of ischemic brain tissue preoperatively was performed. Outcome was analysed according to modified Rankin Scale (mRS) and dichotomized into favorable (mRS 0-3) and unfavorable (mRS 4-5) outcome after 1 year.

Results: Overall, favorable outcome was achieved in 6 of 28 patients (21%). In patients with infarction of 1 large vessel territory, favorable outcome was achieved in 6 of 10 patients (60%) and in none of 18 patients (0%) with infarction of > 1 large vessel territory (p = 0.0006). In patients with infarction of ≤ 2 segments favorable outcome was achieved in 6 of 8 patients (75%) and in none of 20 patients (0%) with infarction of > 2 segments (p = < 0.0001). Infarct volume was associated with an unfavorable outcome after exceeding a cut-off volume of 100 cm3.

Conclusion: Our data indicates, that DC for vasospasm related infarction after aSAH seems to be a valid treatment option in a specified subgroup of these patients. Regarding long-term neurological outcome, patients with infarction in only one large vessel territory or ≤ two segments and patients with ischemic tissue volume £ 100 cm3 seem to benefit from this treatment option. Careful decision making is needed in each individual case.