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Published on: August 11, 2015
Surgical results after primary decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage
Naoki Otani1, Hiroshi Nawashiro, Kojiro Wada
1Department of Neurosurgery, National Defense Medical College, Saitama, Japan. naotani@ndmc.ac.jp
Insights
Decompressive craniectomy (DC) may improve outcomes for patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH). This study suggests DC can reduce mortality and improve results in these critical cases.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Poor-grade aneurysmal subarachnoid hemorrhage (SAH) is associated with significant mass effect and brain stem compression, leading to poor patient outcomes.
- Intracranial hypertension is a major challenge in managing SAH, often contributing to secondary brain injury.
- Decompressive craniectomy (DC) is an established procedure for managing refractory intracranial hypertension.
Purpose of the Study:
- To evaluate the efficacy of decompressive craniectomy (DC) in improving surgical outcomes for patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH).
- To assess the impact of DC on mortality and functional recovery in this specific patient cohort.
Main Methods:
- Retrospective review of 15 patients who underwent DC for poor-grade SAH between August 2005 and July 2010.
- Analysis of medical charts and radiological findings.
- Assessment of patient outcomes using the Glasgow Outcome Scale (GOS) at discharge.
Main Results:
- Among 15 DC patients, 1 (6.7%) had a good outcome, 6 (40.0%) moderate disability, 4 (28.1%) severe disability, 2 (13.3%) vegetative state, and 2 (13.3%) died.
- Notably, 3 (50.0%) of the grade IV patients achieved a favorable outcome.
- The overall mortality rate in the studied DC group was 13.3%.
Conclusions:
- Decompressive craniectomy (DC) appears to be an effective intervention for reducing mortality in patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH).
- DC may offer improved outcomes, including favorable results in some severe cases (e.g., grade IV SAH).
- Further research into the mechanisms, such as improved perfusion or reduced intracranial pressure, supports the use of DC in selected SAH patients.
Abstract:
It is well known that patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) have poor outcomes owing to significant mass effect and brain stem compression. On the other hand, decompressive craniectomy (DC) has shown efficacy in reducing morbidity and mortality in patients with intracranial hypertension. Here, we study the efficacy of DC in poor-grade SAH with attention to surgical outcome. A total of 38 consecutive patients with poor-grade SAH was treated in our hospital between 1 August 2005 and 30 July 2010. Among these 38 patients, we involved 15 patients with DC in the present study. We retrospectively reviewed medical charts and radiological findings. Glasgow Outcome Scale score on discharge showed good response in 1 (6.7 %), moderate disability in 6 (40.0 %), severe disability in 4 (28.1 %), vegetative state in 2 (1.3 %), and death in 2 (13.3 %). In particular, 3 grade IV patients (50.0 %) had a favorable outcome. Recent several experimental studies also indicated that DC significantly improves outcome owing to increased perfusion pressure or reduced intracranial pressure. We suggest that the DC provided the efficacy in reducing mortality in poor-grade SAH patients.
