Decompressive hemicraniectomy after aneurysmal subarachnoid hemorrhage.

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Aneurysmal subarachnoid hemorrhage (SAH) can lead to uncontrollable intracranial hypertension.
• Decompressive hemicraniectomy (DHC) is a surgical option for managing this severe complication.
• Evaluating DHC's impact on neurologic outcomes in SAH patients is crucial.

Purpose of the Study:

• To assess the effects of DHC on neurologic outcomes in patients with aneurysmal SAH and intracranial hypertension.
• To determine if the timing of DHC influences patient outcomes.
• To correlate outcomes with the underlying pathology causing intracranial hypertension.

Main Methods:

• Retrospective analysis of 66 patients who underwent DHC after aneurysmal SAH.
• Stratification into groups based on surgical timing (primary vs. delayed DHC) and initial treatment (clipping vs. embolization).
• Comparison of neurologic outcomes (modified Rankin Scale scores) between patients with hematomas and those with edema/ischemic infarctions.

Main Results:

• Neurologic outcome was dependent on the pathology (hematoma vs. edema/ischemia), not the timing of DHC.
• Patients with space-occupying hematomas undergoing DHC had significantly better outcomes (34.8% favorable) compared to those with edema/ischemic infarctions (10.0% favorable).
• Favorable outcomes (mRS 0-3) were observed in 16/46 hematoma patients versus 2/20 ischemia patients (P=0.038).

Conclusions:

• DHC positively impacts neurologic outcomes in SAH patients with space-occupying hematomas.
• Patients with delayed ischemic strokes secondary to SAH do not benefit as significantly from DHC.
• Pathology underlying intracranial hypertension is a key determinant of DHC effectiveness in SAH.