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Published on: August 11, 2015
Decompressive craniectomy following subarachnoid hemorrhage: A prospective Swedish multicenter study
Bryndís Baldvinsdóttir1, Erik Kronvall1, Elisabeth Ronne-Engström2
1Department of Clinical Sciences, Neurosurgery, Lund University, Lund, Sweden.
Insights
Decompressive craniectomy is uncommon in severe aneurysmal subarachnoid hemorrhage patients. Risk factors include poor grade and MCA aneurysm, with 71% experiencing unfavorable outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Decompressive craniectomy (DC) is a critical intervention for severe aneurysmal subarachnoid hemorrhage (aSAH).
- Understanding the utilization, risk factors, and outcomes of DC in aSAH is essential for clinical practice.
Purpose of the Study:
- To investigate the incidence and utilization of DC in aSAH patients in Sweden.
- To identify risk factors associated with undergoing DC for aSAH.
- To evaluate the functional outcomes of aSAH patients treated with DC.
Main Methods:
- Nationwide prospective study of aSAH patients in Sweden (2014-2018).
- Analysis of clinical, radiological, and treatment factors using Chi-Square and logistic regression.
- Functional outcome assessment using the extended Glasgow Outcome Scale at one year.
Main Results:
- 3.4% (35/1037) of aSAH patients underwent DC.
- Independent risk factors for DC included poor pre-treatment grade, MCA aneurysm, cerebral edema, and adverse events during aneurysm occlusion.
- At one-year follow-up, 71% of patients who underwent DC had an unfavorable functional outcome.
Conclusions:
- Decompressive craniectomy is infrequently used in aSAH patients.
- DC is associated with a higher risk of unfavorable functional outcomes.
- Adverse events during aneurysm occlusion are significant predictors for DC in aSAH.
Introduction:
Decompressive craniectomy (DC) in patients with severe aneurysmal subarachnoid hemorrhage (aSAH) can be a life-saving procedure. The aim of this nationwide prospective study was to investigate the use of DC in aSAH patients in Sweden.
Research Question:
To explore the risk factors and functional outcome associated with DC in patients with aSAH.
Material And Methods:
Patients treated for aSAH at all neurosurgical centers in Sweden during a 3.5-year period (2014-2018) were prospectively registered. Clinical, radiological and treatment-related factors with regard to DC were analyzed using Chi-Square and logistic regression analysis. Functional outcome was assessed by the extended Glasgow outcome scale one year after the bleeding.
Results:
During the study period, 1037 patients were treated for aSAH. Thirty-five patients (3.4%) underwent DC. At one year follow-up, 25 of these (71%) had unfavorable functional outcome. Multivariate logistic regression analysis revealed that poor clinical grade before aneurysm treatment, middle cerebral artery (MCA) aneurysm, edema on the initial computed tomography (CT), and adverse events during aneurysm occlusion were independent and significant risk factors for performing DC.
Discussion And Conclusion:
DC is relatively uncommon in aSAH patients and is related to increased risk of unfavorable outcome. However, favorable functional outcome was seen in 29% of patients with DC. Adverse events during aneurysm occlusion were significant risk factors for DC.
