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Published on: August 11, 2015
Decompressive craniectomy in patients with aneurysmal subarachnoid hemorrhage: a single-center matched-pair analysis
Yoichi Uozumi1, Oliver Sakowitz, Berk Orakcioglu
1Department of Neurosurgery, Kamiiida Dai-ichi General Hospital, Nagoya, Japan.
Insights
Decompressive craniectomy (DC) did not significantly improve outcomes for aneurysmal subarachnoid hemorrhage (aSAH) patients in this study. While not offering a clear advantage, DC may benefit a specific subset of aSAH patients.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Decompressive craniectomy (DC) use in aneurysmal subarachnoid hemorrhage (aSAH) remains controversial.
- Evaluating the impact of DC on aSAH patient outcomes is crucial for clinical decision-making.
Purpose of the Study:
- To assess the efficacy of decompressive craniectomy (DC) in improving outcomes for patients with aneurysmal subarachnoid hemorrhage (aSAH).
Main Methods:
- A matched-pair analysis compared 56 aSAH patients who underwent DC with 56 matched controls.
- Matching criteria included age, gender, World Federation of Neurosurgical Societies (WFNS) grade, Fisher group, and vasospasm occurrence.
- Outcomes were assessed at 1 month and 1 year post-intervention.
Main Results:
- At 1 month, 96.4% of DC patients were dependent/dead versus 87.5% of controls (p=0.16).
- At 1 year, 72.2% of DC patients were dependent/dead versus 55.6% of controls (p=0.11).
- No significant differences were observed between groups, irrespective of patient characteristics or timing/reason for DC.
Conclusions:
- Decompressive craniectomy (DC) showed no significant advantage for aSAH patients in this cohort.
- A notable percentage (over 25%) achieved good long-term outcomes, suggesting potential benefit in specific cases.
- Further comparative studies are necessary to clarify the role of DC in aSAH management.
Background:
The role of decompressive craniectomy (DC) in aneurysmal subarachnoid hemorrhage (aSAH) patients is still controversial. In this study we evaluated the effect of DC for aSAH patients.
Methods:
A matched-pair analysis was performed to compare the outcomes of patients with DC to those of patients without DC. Among 295 consecutive aSAH patients, 56 required DC. Of the remaining group, 56 matched controls were found. The match was conducted on the basis of epidemiological and potential prognostic factors, such as age, gender, World Federation of Neurosurgical Societies (WFNS) grade, Fisher group and occurrence of vasospasm.
Results:
Fifty-four of 56 (96.4%) patients with DC were dependent or dead at 1 month, compared with 49 of 56 (87.5%) without DC. There was no significant difference between the groups (p = 0.16). One-year outcomes were available for 108 patients (96.4%). Thirty-nine of 54 (72.2%) patients treated with DC were dependent or dead at 1 year, compared with 30 of 54 (55.6%) patients in the control group. There was no significant difference between the groups (p = 0.11). This result was unaffected by age, sex and WFNS grade. Subgroup analyses whether DC was performed primarily or delayed, and whether DC was performed due to spasm, hematoma or vessel occlusion failed to detect any significant difference.
Conclusion:
There was no significant advantage for patients treated with DC, but more than 25% achieved a good long-term outcome. While the value of DC is deemed uncertain, it may be effective for a very specific subset of aSAH patients. Further comparative studies are needed to resolve this matter.
