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Decompressive hemicraniectomy in patients with supratentorial intracerebral hemorrhage.
Stroke. 2012 Dec; 43(12):3207-11.S

Abstract

BACKGROUND AND PURPOSE

Decompressive craniectomy (DC) lowers intracranial pressure and improves outcome in patients with malignant middle cerebral artery stroke. Its usefulness in intracerebral hemorrhage (ICH) is unclear. The aim of this study was to analyze feasibility and safety of DC without clot evacuation in ICH.

METHODS

We compared consecutive patients (November 2010-January 2012) with supratentorial ICH treated with DC without hematoma evacuation and matched controls treated by best medical treatment. DC measured at least 150 mm and included opening of the dura. We analyzed clinical (age, sex, pathogenesis, Glasgow Coma Scale, National Institutes of Health Stroke Scale), radiological (signs of herniation, side and size of hematoma, midline shift, hematoma expansion, distance to surface), and surgical (time to and indication for surgery) characteristics. Outcome at 6 months was dichotomized into good (modified Rankin Scale 0-4) and poor (modified Rankin Scale 5-6).

RESULTS

Twelve patients (median age 48 years; interquartile range 35-58) with ICH were treated by DC. Median hematoma volume was 61.3 mL (interquartile range 37-83.5 mL) and median preoperative Glasgow Coma Scale was 8 (interquartile range 4.3-10). Four patients showed signs of herniation. Nine patients had good and 3 had poor outcomes. Three patients (25%) of the treatment group died versus 8 of 15 (53%) of the control group. There were 3 manageable complications related to DC.

CONCLUSIONS

DC is feasible in patients with ICH. Based on this small cohort, DC may reduce mortality. Larger prospective cohorts are warranted to assess safety and efficacy.

Authors+Show Affiliations

Department of Neurosurgery, University Hospital Bern, 10 Freiburgstrasse, 3010 Bern, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23111437

Citation

Fung, Christian, et al. "Decompressive Hemicraniectomy in Patients With Supratentorial Intracerebral Hemorrhage." Stroke, vol. 43, no. 12, 2012, pp. 3207-11.
Fung C, Murek M, Z'Graggen WJ, et al. Decompressive hemicraniectomy in patients with supratentorial intracerebral hemorrhage. Stroke. 2012;43(12):3207-11.
Fung, C., Murek, M., Z'Graggen, W. J., Krähenbühl, A. K., Gautschi, O. P., Schucht, P., Gralla, J., Schaller, K., Arnold, M., Fischer, U., Mattle, H. P., Raabe, A., & Beck, J. (2012). Decompressive hemicraniectomy in patients with supratentorial intracerebral hemorrhage. Stroke, 43(12), 3207-11. https://doi.org/10.1161/STROKEAHA.112.666537
Fung C, et al. Decompressive Hemicraniectomy in Patients With Supratentorial Intracerebral Hemorrhage. Stroke. 2012;43(12):3207-11. PubMed PMID: 23111437.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decompressive hemicraniectomy in patients with supratentorial intracerebral hemorrhage. AU - Fung,Christian, AU - Murek,Michael, AU - Z'Graggen,Werner J, AU - Krähenbühl,Anna K, AU - Gautschi,Oliver P, AU - Schucht,Philippe, AU - Gralla,Jan, AU - Schaller,Karl, AU - Arnold,Marcel, AU - Fischer,Urs, AU - Mattle,Heinrich P, AU - Raabe,Andreas, AU - Beck,Jürgen, Y1 - 2012/10/30/ PY - 2012/11/1/entrez PY - 2012/11/1/pubmed PY - 2013/2/6/medline SP - 3207 EP - 11 JF - Stroke JO - Stroke VL - 43 IS - 12 N2 - BACKGROUND AND PURPOSE: Decompressive craniectomy (DC) lowers intracranial pressure and improves outcome in patients with malignant middle cerebral artery stroke. Its usefulness in intracerebral hemorrhage (ICH) is unclear. The aim of this study was to analyze feasibility and safety of DC without clot evacuation in ICH. METHODS: We compared consecutive patients (November 2010-January 2012) with supratentorial ICH treated with DC without hematoma evacuation and matched controls treated by best medical treatment. DC measured at least 150 mm and included opening of the dura. We analyzed clinical (age, sex, pathogenesis, Glasgow Coma Scale, National Institutes of Health Stroke Scale), radiological (signs of herniation, side and size of hematoma, midline shift, hematoma expansion, distance to surface), and surgical (time to and indication for surgery) characteristics. Outcome at 6 months was dichotomized into good (modified Rankin Scale 0-4) and poor (modified Rankin Scale 5-6). RESULTS: Twelve patients (median age 48 years; interquartile range 35-58) with ICH were treated by DC. Median hematoma volume was 61.3 mL (interquartile range 37-83.5 mL) and median preoperative Glasgow Coma Scale was 8 (interquartile range 4.3-10). Four patients showed signs of herniation. Nine patients had good and 3 had poor outcomes. Three patients (25%) of the treatment group died versus 8 of 15 (53%) of the control group. There were 3 manageable complications related to DC. CONCLUSIONS: DC is feasible in patients with ICH. Based on this small cohort, DC may reduce mortality. Larger prospective cohorts are warranted to assess safety and efficacy. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/23111437/Decompressive_hemicraniectomy_in_patients_with_supratentorial_intracerebral_hemorrhage_ L2 - https://www.ahajournals.org/doi/10.1161/STROKEAHA.112.666537?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -