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Decompressive craniectomy for intracerebral haemorrhage in contemporary practice: a Swedish, multi-centre study of
Klas Holmgren1, Alba Corell2,3, Merete Sunila2
1Department of Clinical Science - Neurosciences, Umeå University, Umeå, Sweden.
Insights
Decompressive craniectomy (DC) for spontaneous supratentorial intracerebral hemorrhage (ICH) in selected patients significantly reduces mass effect. This procedure offers a favorable outcome for 40% of patients, highlighting the importance of careful patient selection.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Spontaneous supratentorial intracerebral hemorrhage (ICH) is a severe neurological condition.
- Decompressive craniectomy (DC) is a surgical option for managing increased intracranial pressure in ICH.
- Indications and outcomes of DC for ICH require further elucidation.
Purpose of the Study:
- To describe the indications for decompressive craniectomy (DC).
- To evaluate the outcomes of spontaneous supratentorial intracerebral hemorrhage (ICH) patients treated with DC.
- To analyze factors influencing outcomes after DC for ICH.
Main Methods:
- A multi-centre retrospective study included 45 patients undergoing DC for spontaneous ICH.
- Data on clinical, radiological, and outcome parameters were extracted.
- Outcomes were assessed at six months using the modified Rankin Scale (mRS).
Main Results:
- DC was performed in a selected ICH population, with 89% undergoing ICH evacuation.
- Significant improvements in midline shift and basal cistern compression were observed postoperatively.
- At six months, 28% of patients were deceased, and 40% had a favorable outcome (mRS 0-3).
Conclusions:
- Decompressive craniectomy (DC) in selected spontaneous supratentorial intracerebral hemorrhage (ICH) patients leads to significant mass effect reduction.
- A relatively high rate of favorable outcomes was observed, emphasizing the critical role of patient selection.
- Larger prospective studies are warranted to further refine patient selection and treatment protocols.
Background:
This multi-centre study aimed to describe indications and outcomes in spontaneous supratentorial intracerebral haemorrhage (ICH) patients treated with decompressive craniectomy (DC).
Methods:
All patients undergoing DC for spontaneous ICH at five Swedish neurosurgical centres between 2008 and 2022 were included (n = 45). Clinical, radiological, and outcome data were extracted. Outcome at six months was assessed using the modified Rankin Scale (mRS), dichotomized as favourable vs. unfavourable (mRS 0-3 vs. 4-6), and survival vs. mortality (mRS 0-5 vs. 6).
Results:
Based on estimated ICH incidence, DC was performed in approximately 1.5 per 1000 cases. Median age was 47 years and the median ICH volume was 51 mL. Eighty-nine percent underwent ICH evacuation. DC performed as a primary procedure without ICP monitoring in 33%, whereas 67% underwent secondary DC due to refractory ICP elevation. Preoperative midline shift (median 11 mm) and basal cistern compression (present in 96%) significantly improved postoperatively (p < 0.001). Reoperation occurred in <10%. At follow-up, 28% were deceased and 40% had recovered favourably.
Conclusions:
DC performed in a highly selected ICH population resulted in significant mass effect reduction and a relatively high rate of favourable outcome. Patient selection remains crucial but challenging, and larger prospective studies are warranted.
