title: Clinical characteristics and surgical outcomes of patients with aneurysmal subarachnoid hemorrhage and acute subdural hematoma undergoing decompressive craniectomy.
abstract: OBJECTIVE
  This report presents 12 consecutively managed patients with aneurysmal subarachnoid hemorrhage (SAH) associated with acute subdural hematoma (ASDH) who underwent decompressive craniectomy (DC) with special attention to their clinical characteristics and surgical outcomes.
  
  
  METHODS
  We retrospectively reviewed medical charts, radiologic findings, surgical notes, and video records.
  
  
  RESULTS
  Among these 12 patients (mean age 59.1 years, 4 men, 8 women), the Hunt and Kosnik clinical grade was grade V in 7 patients (58.3%), grade IV in 2 patients (16.7%), grade III in 2 patients (16.7%), and grade II in 1 patient (8.3%). The aneurysms were located on the internal carotid artery in four patients, the middle cerebral artery in six patients, and the anterior communicating artery in two patients. Computed tomography findings on admission revealed ASDH in all patients. In addition, SAH was seen in 11 patients. An intracerebral hematoma was found in eight patients, intraventricular hemorrhaging occurred in four, and an acute hydrocephalus was seen in one patient. All patients underwent a microsurgical clipping procedure and an additional DC. Symptomatic vasospasm was confirmed in six (50%), and eight patients with chronic hydrocephalus received a ventriculoperitoneal shunt (67%). The Glasgow Outcome Scale at discharge showed good recovery in five patients (41.7%), severe disability in four (33.3%), vegetative state in two (16.7%), and death in one patient (8.3%). A favorable outcome was achieved in five patients (41.7%).
  
  
  CONCLUSIONS
  We suggest that the DC was effective for reducing morbidity and mortality in poor grade patients with SAH presenting with ASDH.
authors.affiliation: Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Otani
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takasato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Masaoka
authors.forename: Takanori
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yoshino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsushige
authors.forename: Hiroki
authors.initials: H
authors.lastname: Miyawaki
authors.forename: Kyoko
authors.initials: K
authors.lastname: Sumiyoshi
authors.forename: Takashi
authors.initials: T
authors.lastname: Sugawara
authors.forename: Aoyagi
authors.initials: A
authors.lastname: Chikashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Goh
authors.initials: G
authors.lastname: Suzuki
mesh_terms: D056424:Decompressive Craniectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D023261:Glasgow Outcome Scale; D020199:Hematoma, Subdural, Acute / Q000150:complications / Q000601:surgery*; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000601:surgery; D017287:Ventriculoperitoneal Shunt