title: Decompressive hemi-craniectomy is not necessary to rescue supratentorial hypertensive intracerebral hemorrhage patients: consecutive single-center experience.
abstract: OBJECTIVE
  A consensus on decompressive surgery for hypertensive intracranial hemorrhage (ICH) has not been reached. We retrospectively analyzed our single-center experience with ICH.
  
  
  METHODS
  From January 2004 to August 2009, 65 consecutive supratentorial ICH patients underwent surgery in our institute. Supratentorial ICHs that exhibited a hematoma volume of over 50 mL according to the xyz/2 method were included in this study. We compared a hematoma removal plus decompressive craniectomy group (DC) and a hematoma removal group (HR) with regard to GCS, preoperative hematoma volume, shift from the midline, time from the ictus to surgery, post-surgical hematoma volume, brain swelling, hospitalization periods, and m-RS after 3 months. Statistical analysis was done using the t-test or χ2 test, and the odds ratio was calculated.
  
  
  RESULTS
  Twenty-five patients participated in this study. The DC group included 5 male patients, and the HR group 20 patients (F/M=8/12). Mean DC group age was 44.2 years, and 56.8 years for the HR group (p<0.05). GCS, preoperative hematoma volume, shift from the midline, time from the ictus to surgery, and postoperative hematoma volume were similar between both groups. Brain swelling on post-operative [corrected] CT was demonstrated to be mild and delimited within the cranium in the DC group, similar to the HR group. Hospitalization periods increased in the DC group (p<0.05). The m-RS after 3 months was similar for both groups. The factors relevant for m-RS were age, postoperative hematoma volume, and GCS at 24 h after surgery.
  
  
  CONCLUSIONS
  Decompressive craniectomy is not necessary for rescue in ICH if the hematoma can be removed completely.
authors: Department of Neurosurgery, Hirosaki University School of Medicine, 5-Zaihuchou, Hirosaki, Aomori, 036-8562, Japan. shimab@cc.hirosaki-u.ac.jp
authors: Norihito
authors: N
authors: Shimamura
authors: Akira
authors: A
authors: Munakata
authors: Masato
authors: M
authors: Naraoka
authors: Takahiro
authors: T
authors: Nakano
authors: Hiroki
authors: H
authors: Ohkuma
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D056424:Decompressive Craniectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000209:etiology; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013396:Suction / Q000009:adverse effects / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome