title: Decompressive hemicraniectomy for poor-grade aneurysmal subarachnoid hemorrhage patients with associated intracerebral hemorrhage: clinical outcome and quality of life assessment.
abstract: OBJECTIVE
  Decompressive hemicraniectomy has been proposed as a potential treatment strategy in patients with poor-grade aneurysmal subarachnoid hemorrhage presenting with focal intracerebral hemorrhage causing significant mass effect. Although hemicraniectomy improves overall survival rates, the long-term quality of life (QoL) for survivors in this patient population has not been reported.
  
  
  METHODS
  Using adjudicated outcome assessments, we compare long-term clinical outcomes and QoL between a group of patients with poor-grade aneurysmal subarachnoid hemorrhage receiving decompressive hemicraniectomy (n=12) and a control group of similar patients managed more conservatively (n=10).
  
  
  RESULTS
  Patients receiving decompressive hemicraniectomy experienced a statistically insignificant decrease in short-term mortality compared with controls (25 versus 42%); however, long-term QoL in hemicraniectomy survivors was generally poor. Furthermore, hemicraniectomy patients did not experience an increase in mean quality-adjusted life years over control patients (2.31 versus 2.22 yr).
  
  
  CONCLUSIONS
  Decompressive hemicraniectomy prolongs short-term survival in patients with poor-grade aneurysmal subarachnoid hemorrhage with associated intracerebral hemorrhage; however, this trend is not statistically significant, and the overall QoL experienced by survivors is poor. Decompressive hemicraniectomy may be indicated if performed early in a select subset of patients. On the basis of our preliminary data, large prospective studies to investigate this issue further may not be warranted.
authors.affiliation: Department of Neurological Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: D'Ambrosio
authors.forename: Michael E
authors.initials: ME
authors.lastname: Sughrue
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Yorgason
authors.forename: J D
authors.initials: JD
authors.lastname: Mocco
authors.forename: Kurt T
authors.initials: KT
authors.lastname: Kreiter
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Guy M
authors.initials: GM
authors.lastname: McKhann
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome