title: Decompressive craniectomy with hematoma evacuation for large hemispheric hypertensive intracerebral hemorrhage.
abstract: Hemispheric hypertensive intracerebral hemorrhage (ICH) has a high mortality rate. Decompressive craniectomy (DC) has generally been used for the treatment of severe traumatic brain injury, aneurysmal subarachnoid hemorrhage, and hemispheric cerebral infarction. However, the effect of DC on hemispheric hypertensive ICH is not well understood. To investigate the effects of DC for treating hemispheric hypertensive ICH, we retrospectively reviewed the clinical and radiological findings of 21 patients who underwent DC for hemispheric hypertensive ICH. Eleven of the patients were male and 10 were female, with an age range of 22-75 years (mean, 56.6 years). Their preoperative Glasgow Coma Scale scores ranged from 3 to 13 (mean, 6.9). The hematoma volumes ranged from 33.4 to 98.1 mL (mean, 74.2 mL), and the hematoma locations were the basal ganglia in 10 patients and the subcortex in 11 patients. Intraventricular extensions were observed in 11 patients. With regard to the complications after DC, postoperative hydrocephalus developed in ten patients, and meningitis was observed in three patients. Six patients had favorable outcomes and 15 had poor outcomes. The mortality rate was 10 %. A statistical analysis showed that the GCS score at admission was significantly higher in the favorable outcome group than that in the poor outcome group (P = 0.029). Our results suggest that DC with hematoma evacuation might be a useful surgical procedure for selected patients with large hemispheric hypertensive ICH.
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan. s.takeuchi@room.ocn.ne.jp
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeuchi
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: Hiroshi
authors.initials: H
authors.lastname: Yatsushige
authors.forename: Keigo
authors.initials: K
authors.lastname: Shigeta
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Nagatani
authors.forename: Naoki
authors.initials: N
authors.lastname: Otani
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nawashiro
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shima
mesh_terms: D000328:Adult; D000368:Aged; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult