ABSTRACT
INTRODUCTION: Despite the scientific and technical advances of recent years, aneurysmal subarachnoid hemorrhage (aSAH) continues to present a high morbidity and mortality. This fact, together with the impressive results of the primary decompressive craniotomy (PDC) in the malignant infarction of the middle cerebral artery suggests a possible beneficial effect of decompressive technique in aSAH. We present our experience of a pilot study that PDC was used in patients with poorgrade aSAH with associated intracerebral hematoma. PATIENTS AND METHODS: Between March 1st, 2002 and 31st April, 2008, 342 patients with aneurysmatic subarachnoid hemorrhage (aSAH) were treated at our hospital. Of these, 64 had a poor neurological grade (scores of 4 or 5 of the World Federation of Neurosurgical Societies) at the time of admission. The present study examines 11 of those patients who underwent PDC, which is performed in the same clipping and / or evacuation of an associated hematoma. RESULTS: In three patients PDC was performed after endovascular aneurysm treatment because of the need to evacuate an associated hematoma. In the eight remaining patients, PDC was performed in the same clipping and evacuation of the associated hematoma. Outcome evaluation of these eleven patients was conducted 1 year after the operation assessed by the Glasgow Outcome Scale. Six patients survived, and four of them with good results. The PDC was effective in controlling intracranial pressure in all six surviving patients. However, two of these six patients had unfavorable outcomes. Of the five who didn't survive, one patient died from a delayed epidural-subgaleal hematoma as a complication of the decompressive technique, and the other four patients died because of refractory intracranial hypertension. CONCLUSIONS: Primary DC may be beneficial in selected subgroups of patients with poor-grade aSAH. However, there is a lack of definitive evidence to support a clear recommendation for its use.
Subject(s)
Decompressive Craniectomy/methods , Subarachnoid Hemorrhage/surgery , Adult , Aged , Female , Glasgow Outcome Scale , Humans , Intracranial Pressure , Male , Middle Aged , Pilot Projects , Treatment Outcome , Young AdultABSTRACT
A pesar de los avances científicos y técnicos de los últimos años, la hemorragia subaracnoidea aneurismática (HSAa) sigue presentando una alta morbilidad y mortalidad. Este hecho, junto con los impresionantes resultados de la craneotomía descompresiva primaria (CDP) en el infarto maligno de la arteria cerebral media sugiere la posibilidad que la CDP sea una alternativa terapéutica a considerar en algunos pacientes con una HSAa. Presentamos nuestra experiencia de un estudio piloto en el que se utilizó la CDP en pacientes con HSAa en mal grado neurológico y hematoma intracerebral asociado. Pacientes y métodos. Entre el 1 de marzo de 2002y el 31 de abril de 2008, se trataron 342 pacientes con HSA a en nuestro hospital. De estos, 64 tenían una puntuación de 4 ó 5 de la escala de la WFNS (World Federation of Neurosurgical Societies). En el presente estudio prospectivo se analizan 11 pacientes en los que se realizó una CDP durante la misma cirugía de clipajeo/y evacuación del hematoma asociado. Resultados. En tres pacientes la CDP se realizó después del tratamiento endovascular del aneurisma debido a la necesidad de evacuar el hematoma asociado. En los ocho pacientes restantes, la CDP se realizó durante el clipaje y la evacuación del hematoma asociado. La evaluación de los resultados de estos once pacientes se llevó a cabo al año de la cirugía mediante la escala de resultados de Glasgow. La CDP fue eficaz en el control de presión intracraneal en los pacientes que sobrevivieron. Seis pacientes sobrevivieron, cuatro de (..) (AU)
Introduction. Despite the scientific and technical advances of recent years, aneurysmal subarachnoid hemorrhage (aSAH) continues to present a high morbidity and mortality. This fact, together with the impressive results of the primary decompressive craniotomy(PDC) in the malignant infarction of the middle cerebralartery suggests a possible beneficial effect of decompressive technique in aSAH. We present our experience of a pilot study that PDC was used in patients with poor grade aSAH with associated intracerebral hematoma. Patients and methods. Between March 1st, 2002 and31st April, 2008, 342 patients with aneurysmatic subarachnoid hemorrhage (aSAH) were treated at our hospital. Of these, 64 had a poor neurological grade (scores of4 or 5 of the World Federation of Neurosurgical Societies)at the time of admission. The present study (..) (AU)