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Decompressive Craniectomy for Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-analysis

Zhong Yao1, Lu Ma1, Chao You1

  • 1Department of Neurosurgery, West China Hospital, Sichuan University and West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, China.

World Neurosurgery
|November 14, 2017
PubMed

Insights

Decompressive craniectomy (DC) reduces mortality in spontaneous intracerebral hemorrhage (sICH) patients. While DC may improve outcomes in specific populations, further research is needed to confirm its benefits.

Area of Science:

  • Neurosurgery
  • Critical Care Medicine
  • Neurology

Background:

  • Spontaneous intracerebral hemorrhage (sICH) is a severe neurological condition with high mortality and morbidity.
  • The efficacy of decompressive craniectomy (DC) in managing sICH remains a subject of debate.
  • This systematic review aims to evaluate the impact of DC on patient outcomes in sICH.

Purpose of the Study:

  • To systematically review and synthesize evidence on the effectiveness of decompressive craniectomy (DC) for spontaneous intracerebral hemorrhage (sICH).
  • To assess the impact of DC on mortality and functional outcomes in patients with sICH.
  • To identify patient subgroups or study characteristics that may influence the effectiveness of DC.

Main Methods:

  • A systematic literature search was conducted across multiple electronic databases.
  • Eligible studies were screened, and data were extracted to calculate risk ratios (RR) with 95% confidence intervals (CI).
  • A fixed-effect model was used for data synthesis, with sensitivity and subgroup analyses performed to explore heterogeneity and publication bias.

Main Results:

  • Decompressive craniectomy (DC) significantly reduced poor outcomes in sICH patients (RR, 0.91; 95% CI, 0.84-0.99; P=0.03).
  • Subgroup analyses indicated improved outcomes with DC in studies published after 2010, those using hematoma evacuation as a control, and those measuring outcomes with the Glasgow Outcome Score.
  • DC significantly decreased mortality rates (RR, 0.67; 95% CI, 0.53-0.85; P=0.0008) with consistent results across sensitivity and subgroup analyses.

Conclusions:

  • Decompressive craniectomy (DC) is effective in reducing mortality for patients suffering from spontaneous intracerebral hemorrhage (sICH).
  • The potential for DC to improve functional outcomes exists in specific patient populations, warranting further investigation.
  • DC does not appear to increase the incidence of postoperative complications such as rebleeding or hydrocephalus.
Abstract

Keywords:
ComplicationDecompressive craniectomyIntracerebral hemorrhageMeta-analysisSpontaneous

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