title: Primary decompressive craniectomy for poor-grade middle cerebral artery aneurysms with associated intracerebral hemorrhage.
abstract: OBJECTIVE
  Aggressive surgery seems mandatory for poor-grade middle cerebral artery (MCA) aneurysm with associated intracerebral hemorrhage (ICH). However, primary decompressive craniectomy (DC) is controversial. We performed a case control study to define the role of primary DC.
  
  
  METHODS
  We analyzed data from the two cohorts: a multicenter prospective poor-grade aSAH registry study (AMPAS); and the National Clinical Research Center for Neurological Diseases (NCRC-ND) database of poor-grade patients. Outcome was assessed by modified Rankin Scale (mRS) and was dichotomized into favorable (mRS 0-3) and unfavorable outcome (mRS 4-6). We compared major complication rates, mortality and outcomes between primary DC and control groups.
  
  
  RESULTS
  Twenty-four patients with primary DC were included in the study group. Fourteen patients without DC were included in the control group. Patients with younger age and lower Glasgow coma score (GCS) more often underwent primary DC. Major complications did not differ between the two groups. Fourteen (58%) patients had a favorable outcome, and the mortality was 29%. Primary DC appeared to have lower in-hospital mortality and have better outcome. Adjusting for age and admission GCS, primary DC was not significantly associated with decreased mortality and improved outcomes.
  
  
  CONCLUSIONS
  Although primary DC does not increase postoperative complication and mortality risk, current results showed primary DC does not seem to be significantly associated with improved outcomes. However, more than one half of patients most benefit from primary DC. Further prospective controlled studies are warranted to clarify the issue.
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease), Beijing, China; Department of Neurosurgery, First affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Neurosurgery, Mayo Clinic, Rochester, USA.
authors: Bing
authors: B
authors: Zhao
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease), Beijing, China.
authors: Yuanli
authors: Y
authors: Zhao
authors: Department of Neurosurgery, First affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors: Xianxi
authors: X
authors: Tan
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease), Beijing, China.
authors: Yong
authors: Y
authors: Cao
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease), Beijing, China.
authors: Jun
authors: J
authors: Wu
authors: Department of Neurosurgery, First affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Electronic address: zhongming158@sohu.com.
authors: Ming
authors: M
authors: Zhong
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease), Beijing, China. Electronic address: captain9858@vip.sina.com.
authors: Shuo
authors: S
authors: Wang
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002539:Cerebral Arterial Diseases / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000601:surgery*; D015331:Cohort Studies; D056424:Decompressive Craniectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology*; D017063:Outcome Assessment, Health Care; D012042:Registries
keywords: Decompressive craniectomy; Intracerebral hemorrhage; Intracranial aneurysm; Middle cerebral artery aneurysm; Subarachnoid hemorrhage