Decompressive hemicraniectomy without clot evacuation in supratentorial deep-seated intracerebral hemorrhage

• Published in: Clinical neurology and neurosurgery 2018-11, Vol.174, p.1-6
• Main Authors: Rasras, S., Safari, H., Zeinali, M., Jahangiri, M.
• Format: Article
• Language: English
• Subjects: Brain research; Coma; Conflicts of interest; Consciousness; Decompresive craniectomy; Glasgow Outcome Scale; Hematoma; Hematoma evacuation; Hemorrhage; Hypertension; Intracerebral Hemorrhage; Intracranial pressure; Morbidity; Mortality; Neurology; Neurosurgery; Ostomy; Patients; Skull; Statistical analysis; Surgery
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2018.08.017

•Decompressive craniectomy without clot evacuation lowers intracranial pressure.•good outcome for patients with hematoma evacuation was slightly higher.•two groups in terms of mortality at 6 months were similar.•two groups in terms of GOS at 6 months were similar. Decompressive craniectomy (DC) lowers intracranial pressure and improves outcomes in patients with malignant middle cerebral artery stroke; yet, its usefulness in intracerebral hemorrhage (ICH) is unclear. The authors sought to assess the preliminary utility of decompressive hemicraniectomy (DHC) without clot evacuation in patients with deep-seated supratentorial ICH. Patients with deep seated spontaneous ICH who were admitted to the Golestan Hospital, of Ahvaz, from November 2014 to February 2016, were prospectively enrolled in this study. A prospective clinical trial where 30 patients diagnosed having large hypertensive ICH was randomly allocated to either group A or B using permuted-block randomization. These patients (n = 30), who all had large deep seated supratentorial ICH with surgery indications, were randomly divided to two groups. ultimately, in one group (n = 13), large DHC was performed without clot evacuation, while in the other (n = 17), craniotomy with clot evacuation was done. Data pertaining to the patients' characteristics and treatment outcomes were prospectively collected. There was no statistically significant difference between two treatment groups (P > 0.05). No significant difference was observed between the two groups in terms of mortality and GOS at 6 months (P > 0.05); nevertheless, the good outcome (Glasgow Outcome Scale = 4–5) for patients with hematoma evacuation was slightly higher (35.3%) as compared to the DHC patients without clot evacuation (30.7%). Decompresive craniectomy without clot evacuation in deep seated ICH can be accomplished with identical mortality and outcome in comparison to patient that undergone clot evacuation.