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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.
Brain & Spine
|March 17, 2025
Summary
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.
