title: Surgical results after primary decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage.
abstract: It is well known that patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) have poor outcomes owing to significant mass effect and brain stem compression. On the other hand, decompressive craniectomy (DC) has shown efficacy in reducing morbidity and mortality in patients with intracranial hypertension. Here, we study the efficacy of DC in poor-grade SAH with attention to surgical outcome. A total of 38 consecutive patients with poor-grade SAH was treated in our hospital between 1 August 2005 and 30 July 2010. Among these 38 patients, we involved 15 patients with DC in the present study. We retrospectively reviewed medical charts and radiological findings. Glasgow Outcome Scale score on discharge showed good response in 1 (6.7 %), moderate disability in 6 (40.0 %), severe disability in 4 (28.1 %), vegetative state in 2 (1.3 %), and death in 2 (13.3 %). In particular, 3 grade IV patients (50.0 %) had a favorable outcome. Recent several experimental studies also indicated that DC significantly improves outcome owing to increased perfusion pressure or reduced intracranial pressure. We suggest that the DC provided the efficacy in reducing mortality in poor-grade SAH patients.
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Saitama, Japan. naotani@ndmc.ac.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Otani
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nawashiro
authors.forename: Kojiro
authors.initials: K
authors.lastname: Wada
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Nagatani
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Hideo
authors.initials: H
authors.lastname: Osada
authors.forename: Takamoto
authors.initials: T
authors.lastname: Suzuki
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shima
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome