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Updated: May 25, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Baseline Characteristics Associated with Improved Outcomes in Patients Undergoing Primary Decompressive Craniectomy
Rimantas Vilcinis1, Raimondas Juskys1,2, Lukas Piliponis1
1Department of Neurosurgery, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Insights
Younger patients with specific acute subdural hematoma (aSDH) characteristics may benefit from primary decompressive craniectomy (pDC) after evacuation, potentially improving outcomes. This surgery could enhance survival and functional recovery in carefully selected individuals.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Neurology
Background:
- Acute subdural hematoma (aSDH) evacuation is a critical neurosurgical procedure.
- Identifying optimal surgical candidates for primary decompressive craniectomy (pDC) after aSDH evacuation is crucial for improving patient outcomes.
Purpose of the Study:
- To identify specific patient subgroups who may benefit from primary decompressive craniectomy (pDC) following acute subdural hematoma (aSDH) evacuation.
- To determine predictors of outcome in patients undergoing aSDH evacuation with either osteoplastic craniotomy (OC) or pDC.
Main Methods:
- Retrospective analysis of 290 patients who underwent aSDH evacuation between 2016 and 2021.
- Comparison of preoperative characteristics (age, GCS, hematoma thickness, midline shift, CES) and Glasgow Outcome Scale (GOS) scores between OC and pDC groups.
- Statistical analysis to identify independent predictors of GOS scores, particularly within the pDC subgroup.
Main Results:
- Older age, lower initial GCS, and higher cisternal effacement score (CES) were associated with poorer GOS scores.
- Age and degree of cisternal compression were significant predictors of GOS in the pDC subgroup.
- Younger survivors undergoing pDC had better outcomes compared to deceased patients receiving OC; favorable outcomes after pDC were also associated with younger age.
Conclusions:
- Younger patients (<55 years) with specific preoperative parameters (GCS 4-6, midline shift 1-2 cm, hematoma thickness 1-2.5 cm, CES 7-12) may benefit from pDC after aSDH evacuation.
- pDC has the potential to improve survival and functional outcomes in carefully selected aSDH patients.
- Age and degree of cisternal compression are key factors in predicting outcomes for pDC in aSDH patients.
Abstract:
Background and Objective: The study's aim is to identify a subgroup of patients who would benefit from primary decompressive craniectomy (pDC) after acute subdural hematoma (aSDH) evacuation. Materials and Methods: A retrospective analysis of 290 patients undergoing aSDH evacuation between 2016 and 2021 was conducted. Osteoplastic craniotomy (OC) was performed in 213 cases (73.4%), whereas 77 individuals underwent pDC. Preoperative characteristics, such as age, initial GCS score, hematoma thickness, midline shift, and cisternal effacement score (CES), were used to predict outcome at discharge by the Glasgow Outcome Scale (GOS). Results: Older age, lower initial GCS, and higher CES preoperatively were independently associated with lower GOS scores at discharge. Age and degree of cisternal compression remained significant predictors of GOS score in the pDC subgroup. Survivors who underwent pDC were younger in comparison to deceased individuals receiving OC (mean age 55.43 ± 14.58 vs. 72.28 ± 14.63, p < 0.001). Patients who achieved favorable outcomes after pDC were significantly younger compared to those who had poor outcomes after OC (mean age 49.20 ± 12.05 vs. 72.28 ± 14.32, p < 0.001). Conclusions: Younger patients (<55 years old) with initial GCS scores of 4-6, midline shifts of 1 to 2 cm, subdural hematoma thickness of 1 to 2.5 cm, and CES in a range of 7-12 may benefit from pDC as it could potentially improve survival and functional outcomes after aSDH evacuation.
