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Decompressive Hemicraniectomy for Poor-grade Aneurysmal Subarachnoid Hemorrhage Patients with Associated Intracerebral Hemorrhage: Clinical Outcome and Quality of Life Assessment

D’Ambrosio, Anthony L. M.D.; Sughrue, Michael E. B.S.; Yorgason, Joshua G. B.S.; Mocco, J D. M.D.; Kreiter, Kurt T. M.A.; Mayer, Stephan A. M.D.; McKhann, Guy M. II M.D.; Connolly, E Sander Jr M.D.

doi: 10.1227/01.NEU.0000144820.38439.63
Clinical Studies: CEREBROVASCULAR

OBJECTIVE: Decompressive hemicraniectomy has been proposed as a potential treatment strategy in patients with poor-grade aneurysmal subarachnoid hemorrhage presenting with focal intracerebral hemorrhage causing significant mass effect. Although hemicraniectomy improves overall survival rates, the long-term quality of life (QoL) for survivors in this patient population has not been reported.

METHODS: Using adjudicated outcome assessments, we compare long-term clinical outcomes and QoL between a group of patients with poor-grade aneurysmal subarachnoid hemorrhage receiving decompressive hemicraniectomy (n = 12) and a control group of similar patients managed more conservatively (n = 10).

RESULTS: Patients receiving decompressive hemicraniectomy experienced a statistically insignificant decrease in short-term mortality compared with controls (25 versus 42%); however, long-term QoL in hemicraniectomy survivors was generally poor. Furthermore, hemicraniectomy patients did not experience an increase in mean quality-adjusted life years over control patients (2.31 versus 2.22 yr).

CONCLUSION: Decompressive hemicraniectomy prolongs short-term survival in patients with poor-grade aneurysmal subarachnoid hemorrhage with associated intracerebral hemorrhage; however, this trend is not statistically significant, and the overall QoL experienced by survivors is poor. Decompressive hemicraniectomy may be indicated if performed early in a select subset of patients. On the basis of our preliminary data, large prospective studies to investigate this issue further may not be warranted.

Department of Neurological Surgery, Columbia University, College of Physicians and Surgeons, New York, New York (D’Ambrosio, Sughrue, Yorgason, Mocco)

Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, New York (Kreiter, Mayer)

Department of Neurological Surgery, Columbia University, College of Physicians and Surgeons, New York, New York (McKhann, Connolly)

Reprint requests: Anthony L. D’Ambrosio, M.D., Department of Neurological Surgery, Columbia University, College of Physicians and Surgeons, 710 West 168th Street, New York, NY 10032. Email: ad504@columbia.edu

Received, January 22, 2004.

Accepted, August 27, 2004.

Copyright © by the Congress of Neurological Surgeons