Decompressive hemicraniectomy for poor-grade aneurysmal subarachnoid hemorrhage patients with associated intracerebral hemorrhage: clinical outcome and quality of life assessment.
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.
D'Ambrosio
Anthony L
AL
Department of Neurological Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
Sughrue
Michael E
ME
Yorgason
Joshua G
JG
Mocco
J D
JD
Kreiter
Kurt T
KT
Mayer
Stephan A
SA
McKhann
Guy M
GM
Connolly
E Sander
ES
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