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Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11
Emilia K Pesonen1, Aleksi Lammi1, Cheng Qian1
1Department of Neurosurgery, Oulu University Hospital & University of Oulu, Kajaanintie 52, 90029, Oulu, Finland.
Insights
Decompressive craniectomy (DC) outcomes vary by brain injury type. While effective for traumatic brain injury (TBI), its benefits for subarachnoid hemorrhage (SAH) are less clear compared to ischemic stroke.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Decompressive craniectomy (DC) is a critical intervention for reducing intracranial pressure in severe brain injuries.
- Its efficacy is well-established for traumatic brain injury (TBI) and ischemic stroke.
- However, the effectiveness of DC in subarachnoid hemorrhage (SAH) requires further investigation.
Purpose of the Study:
- To compare mortality and functional outcomes of DC in patients with SAH versus those with TBI or ischemic stroke.
- To elucidate the differential impact of DC based on the underlying etiology of brain injury.
Main Methods:
- Retrospective analysis of all DC procedures at Oulu University Hospital (2009-2019).
- Assessment of mortality and functional outcomes using the Extended Glasgow Outcome Scale (favorable score ≥5).
- Median follow-up duration of 20.7 months.
Main Results:
- 124 DCs were performed; 47% for TBI, 53% for stroke (41% ischemic, 21% SAH).
- Multivariate analysis showed higher unfavorable outcomes in SAH (86%) and ischemic stroke (78%) compared to TBI (48%).
- Mortality rates were 22% (TBI), 17% (ischemic stroke), and 33% (SAH), with no statistically significant differences between stroke types.
Conclusions:
- Favorable outcomes after DC were more frequent in TBI patients than stroke patients in univariate analysis.
- No significant difference in favorable outcomes was observed between SAH and ischemic stroke patients.
- The study highlights the variable effectiveness of DC depending on the cause of brain injury.
Introduction:
Decompressive craniectomy (DC) is a last-tier procedure to lower intracranial pressure in otherwise fatal brain injuries. DC significantly reduces mortality following traumatic brain injury (TBI) and ischemic stroke, but benefits in subarachnoid hemorrhage (SAH) are less clear.
Research Question:
We compared the mortality and functional outcomes in patients who underwent DC after SAH with those who underwent DC following TBI or ischemic stroke.
Materials And Methods:
All DC procedures performed in the Oulu University Hospital between January 2009 and December 2019 were retrospectively identified. Mortality and functional outcomes were assessed during a median follow-up of 20.7 months. Extended Glasgow Outcome Scale scores ≥5 were considered favorable.
Results:
One hundred twenty-four DCs were conducted to patients aged a median of 40 years (SD 16), of whom 88 (71%) were male. Fifty-eight (47%) DCs were due to TBI and 66 (53%) due to stroke. Of the strokes, 41 (62%) were ischemic and 21 (32%) SAH.In multivariate models, the rates of unfavorable outcome were 48% in TBI, 78% in ischemic stroke (OR 2.73, 95% CI 0.70-10.64) and 86% in SAH (OR 3.15, 95%CI 0.67-14.77). Mortality rates were 22% in TBI, 17% in ischemic stroke (OR 0.50, 95%CI 0.11-2.31) and 33% in SAH (OR 0.97, 95%CI 0.24-3.99).
Discussion And Conclusion:
Favorable outcomes were more common in TBI compared to stroke in univariate but not in multivariate analysis. There was no statistically significant difference in the rates of favorable outcomes between SAH and ischemic stroke.
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