title: Decompressive craniectomy for arteriovenous malformation-related intracerebral hemorrhage.
abstract: Arteriovenous malformation (AVM)-related intracerebral hemorrhage (ICH) is the cause of approximately 2-3% of ICH and is an important factor in the significant morbidity and mortality in patients with AVM. Decompressive craniectomy (DC) is a surgical procedure to relieve malignant elevation of intracranial pressure. The use of DC to treat patients with AVM-ICH has been much less common. The present study describes our experience with DC for AVM-ICH and discusses the safety of this procedure. The present retrospective analysis compared 12 consecutive patients treated with DC for AVM-ICH with 23 patients treated with DC for hypertensive ICH. Nine patients were male and three were female, aged from 11 to 53 years (mean, 31.7 years). Hematoma volumes ranged from 50 to 106 ml (mean, 75.8 ml). The outcomes were good recovery in one patient, moderate disability in three, severe disability in seven, and vegetative state in one. Complications after DC included subdural hygroma in four patients, hydrocephalus in one, intracranial infection in two, and intracranial hemorrhage in one. No significant difference was found in the incidence of complications between DC for large AVM-ICH and DC for hypertensive ICH. In conclusion, the present study found no significant difference in the incidence of complications between DC for large AVM-ICH and DC for hypertensive ICH. Further investigations including a prospective randomized trial are needed to confirm the safety and efficacy of DC for the treatment of large AVM-ICH.
authors.affiliation: Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. Electronic address: s.takeuchi@room.ocn.ne.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeuchi
authors.affiliation: Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takasato
authors.affiliation: Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Masaoka
authors.affiliation: Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Nagatani
authors.affiliation: Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Otani
authors.affiliation: Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000209:etiology*; D056424:Decompressive Craniectomy / Q000379:methods; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000601:surgery; D020299:Intracranial Hemorrhage, Hypertensive / Q000209:etiology*; D019586:Intracranial Hypertension / Q000150:complications* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Arteriovenous malformation; Complication; Decompressive craniectomy; Intracerebral hemorrhage; Stroke; Surgery