Role of decompressive craniectomy in the management of poor-grade aneurysmal subarachnoid hemorrhage: short- and long-term outcomes in a matched-pair study.

Abstract

OBJECTIVE:

To evaluate the short- and long-term therapeutic effect and possibility of decompressive craniectomy (DC) for patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH).

METHODS:

Patients suffering from aSAH (Hunt-Hess grades IV, V) who underwent DC from January 2008 to April 2016 were enrolled in this study, and a sample-matched control group was set up. Information regarding participants' demography, clinical characteristics, and neuroimaging findings was systematically established. The outcome of a 6-month to 3-year follow-up was assessed according to the Glasgow outcome scale (GOS), modified Rankin Scale (mRS) and Barthel Index (BI).

RESULTS:

Patients who had DC (21) experienced a statistically significant decrease in short-term mortality compared with those without DC (24, p < 0.05) and showed a decrease in intracranial pressure (ICP) after surgery. However, there was no significant difference in the long-term assessment (GOS/mRS/BI) between the two groups.

CONCLUSIONS:

Some critical patients who have refractory ICP after poor-grade aSAH would benefit from DC for prolonging life in the short term if performed early. Nevertheless, the overall outcome for the long term remains disappointing, larger and longer prospective studies are urgently needed to investigate this issue.

• Authors: Hai Yu, Liang Guo, Junhua He, Jun Kong, Min Yang
• Journal: British journal of neurosurgery (Br J Neurosurg) Vol. 35 Issue 6 Pg. 785-791 (Dec 2021) ISSN: 1360-046X [Electronic] England
• PMID: 32945182 (Publication Type: Journal Article)

Topics

• Decompressive Craniectomy
• Glasgow Outcome Scale
• Humans
• Intracranial Pressure
• Prospective Studies
• Retrospective Studies
• Subarachnoid Hemorrhage (diagnostic imaging, surgery)
• Treatment Outcome