Related Experiment Video
Updated: Jun 22, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Decompressive craniectomy in subarachnoid hemorrhage
Erdem Güresir1, Patrick Schuss, Hartmut Vatter
1Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. Gueresir@em.uni-frankfurt.de
Insights
Decompressive craniectomy (DC) may be beneficial for subarachnoid hemorrhage (SAH) patients with brain swelling, bleeding, or infarction. Prompt intervention is key for favorable outcomes, regardless of the cause or initial patient grade.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) poses significant risks due to potential complications like brain swelling, infarction, and rebleeding.
- Decompressive craniectomy (DC) is a surgical procedure used to reduce intracranial pressure in severe neurological conditions.
- The efficacy of DC in SAH patients with various underlying pathologies requires further investigation.
Purpose of the Study:
- To analyze the outcomes of decompressive craniectomy (DC) in a large cohort of subarachnoid hemorrhage (SAH) patients.
- To evaluate the impact of different underlying pathologies (bleeding, infarction, brain swelling) on DC effectiveness.
- To identify factors influencing favorable outcomes after DC in SAH.
Main Methods:
- A retrospective analysis of 939 subarachnoid hemorrhage (SAH) patients, with 79 undergoing decompressive craniectomy (DC).
- Patients were stratified based on the indication for DC: primary or secondary brain swelling, with or without additional factors like hematoma, rebleeding, or infarcts.
- Outcomes were assessed using the modified Rankin Scale (mRS) at 6 months, with scores 0-3 considered favorable.
Main Results:
- Patients undergoing DC had a significantly higher rate of poor clinical grade on admission compared to those who did not (77.2% vs 34%).
- A favorable outcome (mRS 0-3) was achieved in 26.6% of patients who underwent DC.
- No significant difference in favorable outcomes was observed between primary and secondary DC, or based on the specific underlying indication (brain swelling, bleeding, infarction).
- Multivariate analysis identified acute hydrocephalus and clinical signs of herniation as predictors of unfavorable outcomes.
Conclusions:
- Decompressive craniectomy (DC) may be warranted for subarachnoid hemorrhage (SAH) patients, irrespective of the underlying etiology or initial clinical grade.
- The timing of DC, particularly the interval from intractable intracranial pressure onset, appears critical for achieving favorable outcomes.
- Early intervention, even in later stages of SAH, may improve patient prognosis.
Object:
The aim of this study was to analyze decompressive craniectomy (DC) in the setting of subarachnoid hemorrhage (SAH) with bleeding, infarction, or brain swelling as the underlying pathology in a large cohort of consecutive patients.
Methods:
Decompressive craniectomy was performed in 79 of 939 patients with SAH. Patients were stratified according to the indication for DC: 1) primary brain swelling without or 2) with additional intracerebral hematoma, 3) secondary brain swelling without rebleeding or infarcts, and 4) secondary brain swelling with infarcts or 5) with rebleeding. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months (mRS Score 0-3 favorable vs 4-6 unfavorable).
Results:
Overall, 61 (77.2%) of 79 patients who did and 292 (34%) of the 860 patients who did not undergo DC had a poor clinical grade on admission (World Federation of Neurosurgical Societies Grade IV-V, p < 0.0001). A favorable outcome was attained in 21 (26.6%) of 79 patients who had undergone DC. In a comparison of favorable outcomes in patients with primary (28.0%) or secondary DC (25.5%), no difference could be found (p = 0.8). Subgroup analysis with respect to the underlying indication for DC (brain swelling vs bleeding vs infarction) revealed no difference in the rate of favorable outcomes. On multivariate analysis, acute hydrocephalus (p = 0.009) and clinical signs of herniation (p = 0.02) were significantly associated with an unfavorable outcome.
Conclusions:
Based on the data in this study the authors concluded that primary as well as secondary craniectomy might be warranted, regardless of the underlying etiology (hemorrhage, infarction, or brain swelling) and admission clinical grade of the patient. The time from the onset of intractable intracranial pressure to DC seems to be crucial for a favorable outcome, even when a DC is performed late in the disease course after SAH.
Related Concept Videos
01:29Hemorrhagic Stroke ll: Pathophysiology
01:17Hemorrhagic Stroke l: Introduction