title: Decompressive hemicraniectomy in patients with supratentorial intracerebral hemorrhage.
abstract: OBJECTIVE
  Decompressive craniectomy (DC) lowers intracranial pressure and improves outcome in patients with malignant middle cerebral artery stroke. Its usefulness in intracerebral hemorrhage (ICH) is unclear. The aim of this study was to analyze feasibility and safety of DC without clot evacuation in ICH.
  
  
  METHODS
  We compared consecutive patients (November 2010-January 2012) with supratentorial ICH treated with DC without hematoma evacuation and matched controls treated by best medical treatment. DC measured at least 150 mm and included opening of the dura. We analyzed clinical (age, sex, pathogenesis, Glasgow Coma Scale, National Institutes of Health Stroke Scale), radiological (signs of herniation, side and size of hematoma, midline shift, hematoma expansion, distance to surface), and surgical (time to and indication for surgery) characteristics. Outcome at 6 months was dichotomized into good (modified Rankin Scale 0-4) and poor (modified Rankin Scale 5-6).
  
  
  RESULTS
  Twelve patients (median age 48 years; interquartile range 35-58) with ICH were treated by DC. Median hematoma volume was 61.3 mL (interquartile range 37-83.5 mL) and median preoperative Glasgow Coma Scale was 8 (interquartile range 4.3-10). Four patients showed signs of herniation. Nine patients had good and 3 had poor outcomes. Three patients (25%) of the treatment group died versus 8 of 15 (53%) of the control group. There were 3 manageable complications related to DC.
  
  
  CONCLUSIONS
  DC is feasible in patients with ICH. Based on this small cohort, DC may reduce mortality. Larger prospective cohorts are warranted to assess safety and efficacy.
authors.affiliation: Department of Neurosurgery, University Hospital Bern, 10 Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Fung
authors.forename: Michael
authors.initials: M
authors.lastname: Murek
authors.forename: Werner J
authors.initials: WJ
authors.lastname: Z'Graggen
authors.forename: Anna K
authors.initials: AK
authors.lastname: Krähenbühl
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
authors.forename: Philippe
authors.initials: P
authors.lastname: Schucht
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000601:surgery*; D016208:Databases, Factual; D056424:Decompressive Craniectomy / Q000009:adverse effects* / Q000379:methods*; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome