title: Decompressive craniectomy in patients with aneurysmal subarachnoid hemorrhage: a single-center matched-pair analysis.
abstract: BACKGROUND
  The role of decompressive craniectomy (DC) in aneurysmal subarachnoid hemorrhage (aSAH) patients is still controversial. In this study we evaluated the effect of DC for aSAH patients.
  
  
  METHODS
  A matched-pair analysis was performed to compare the outcomes of patients with DC to those of patients without DC. Among 295 consecutive aSAH patients, 56 required DC. Of the remaining group, 56 matched controls were found. The match was conducted on the basis of epidemiological and potential prognostic factors, such as age, gender, World Federation of Neurosurgical Societies (WFNS) grade, Fisher group and occurrence of vasospasm.
  
  
  RESULTS
  Fifty-four of 56 (96.4%) patients with DC were dependent or dead at 1 month, compared with 49 of 56 (87.5%) without DC. There was no significant difference between the groups (p = 0.16). One-year outcomes were available for 108 patients (96.4%). Thirty-nine of 54 (72.2%) patients treated with DC were dependent or dead at 1 year, compared with 30 of 54 (55.6%) patients in the control group. There was no significant difference between the groups (p = 0.11). This result was unaffected by age, sex and WFNS grade. Subgroup analyses whether DC was performed primarily or delayed, and whether DC was performed due to spasm, hematoma or vessel occlusion failed to detect any significant difference.
  
  
  CONCLUSIONS
  There was no significant advantage for patients treated with DC, but more than 25% achieved a good long-term outcome. While the value of DC is deemed uncertain, it may be effective for a very specific subset of aSAH patients. Further comparative studies are needed to resolve this matter.
authors: Department of Neurosurgery, Kamiiida Dai-ichi General Hospital, Nagoya, Japan.
authors: Yoichi
authors: Y
authors: Uozumi
authors: Oliver
authors: O
authors: Sakowitz
authors: Berk
authors: B
authors: Orakcioglu
authors: Edgar
authors: E
authors: Santos
authors: Modar
authors: M
authors: Kentar
authors: Daniel
authors: D
authors: Haux
authors: Andreas
authors: A
authors: Unterberg
mesh_terms: D000328:Adult; D000368:Aged; D056424:Decompressive Craniectomy / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000601:surgery*