title: Effect of Decompressive Craniectomy on Perihematomal Edema in Patients with Intracerebral Hemorrhage.
abstract: BACKGROUND
  Perihematomal edema contributes to secondary brain injury in the course of intracerebral hemorrhage. The effect of decompressive surgery on perihematomal edema after intracerebral hemorrhage is unknown. This study analyzed the course of PHE in patients who were or were not treated with decompressive craniectomy.
  
  
  METHODS
  More than 100 computed tomography images from our published cohort of 25 patients were evaluated retrospectively at two university hospitals in Switzerland. Computed tomography scans covered the time from admission until day 100. Eleven patients were treated by decompressive craniectomy and 14 were treated conservatively. Absolute edema and hematoma volumes were assessed using 3-dimensional volumetric measurements. Relative edema volumes were calculated based on maximal hematoma volume.
  
  
  RESULTS
  Absolute perihematomal edema increased from 42.9 ml to 125.6 ml (192.8%) after 21 days in the decompressive craniectomy group, versus 50.4 ml to 67.2 ml (33.3%) in the control group (Δ at day 21 = 58.4 ml, p = 0.031). Peak edema developed on days 25 and 35 in patients with decompressive craniectomy and controls respectively, and it took about 60 days for the edema to decline to baseline in both groups. Eight patients (73%) in the decompressive craniectomy group and 6 patients (43%) in the control group had a good outcome (modified Rankin Scale score 0 to 4) at 6 months (P = 0.23).
  
  
  CONCLUSIONS
  Decompressive craniectomy is associated with a significant increase in perihematomal edema compared to patients who have been treated conservatively. Perihematomal edema itself lasts about 60 days if it is not treated, but decompressive craniectomy ameliorates the mass effect exerted by the intracerebral hemorrhage plus the perihematomal edema, as reflected by the reduced midline shift.
authors.affiliation: Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.|Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Fung
authors.affiliation: Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Murek
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Pascal P
authors.initials: PP
authors.lastname: Klinger-Gratz
authors.affiliation: Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Fiechter
authors.affiliation: Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Werner J
authors.initials: WJ
authors.lastname: Z'Graggen
authors.affiliation: Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.affiliation: Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Zbinden
authors.affiliation: Department of Neurology, University Hospital Bern, Bern, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.affiliation: Department of Neurology, University Hospital Bern, Bern, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.affiliation: Department of Neurology, University Hospital Bern, Bern, Switzerland.
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.affiliation: Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.affiliation: Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology / Q000601:surgery; D001929:Brain Edema / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects; D005260:Female; D006406:Hematoma / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome