Skip Navigation LinksHome > January 2005 - Volume 56 - Issue 1 > Decompressive Hemicraniectomy for Poor-grade Aneurysmal Suba...
Neurosurgery:
doi: 10.1227/01.NEU.0000144820.38439.63
Clinical Studies: CEREBROVASCULAR

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.

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Abstract

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.

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