decompresive hemicraniectomy

8/12/2019 Decompresive hemicraniectomy

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Journal reading

Decompresive hemicraniectomy for

spontaneous intracerebral

hemorrhage

Satoru Takeuchi,MD.KojiroWada,MD.Kimihiro Nagatani,MD.

Naoki Otani,MD. and Kentaro

Mori,MD


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Introduction

intracerebral hemorrhage is devastating

decompresive hemicraniectomy is common

and usefull on this procedure

in this review, the present knowledge of the

safety and efficacy of this procedure are

evaluated


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introduction

DHC is surgical procedure to relieve malignant

elevation of ICP.

DHC procedure also has beneficial effect in

reducing ICP and can contribute to

improvement in cerebral compliance, cerebral

oxygen supply, and cerebral blood perfusion.


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Method

A PubMed search for studies was performed

favorable outcome was defined for purpose of

this review as mRS score of 0-2 or GOS

categories good recovery or moderate

disability

poor outcome w defined as mRS score 3-6 or

the GOS category severe disability, vegetative

state, or dead.


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Results

A total 9 studies were identified, reporting 226

cases in wich DHC was performed for

spontaneous hemispheric ICH.

7 study (191 cases) were treated with DHC

with hematome evacuation

2 study (35 cases) were treated with DHC

without hematome evacuation


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DHC with hematoma evacuation

Mean or median patients ages 40-60 years

Preoperative GCS : (>8 or


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DHC with hematoma evacuation

Hematoma volume :

mean and median hematome volume in 4 studies

are relatively large (>60 ml)

time onset to surgery :

7 studies are reported interval time from 3 to 22

hours

4 studies reported 67% from 124 patientsunderwent surgery within 24 hours after onset


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DHC without hematoma evacuation

23 patients : (Ramnarayan et al., 2009) Age range 31-68 years

DHC in putamen hemorrhage

GCS score was 8 or less

Hematome volume was 30-60ml

Underwent DHC 6 hours after onset Outcome was favorable in 13 patients

12 patients : (Fung et al., 2012) Median age 48 years

DHC in basal ganglia or lobar region

Median GCS score is 8 Median hematoma volume 61ml

Underwent DHC 12 hours after onset

Outcome was favorable in 4 patients


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Dicussion (DHC with hematoma evac)

Overall, we found that DHC was performed

mainly in patients with GCS score of 8 or less

an large hematomas (>60ml)

Complication such as hydrocephalus was most

frequent (19% patients with DHC)

DHC with hematoma evac have a favorable

outcome in 41% cases, and overall mortality

rate was 28%


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Dicussion (DHC with hematoma evac)

In this review 53% of patients who underwent

DHC with hematoma evac had associated with

IVH, so this procedure mught have benefit

even for patients with associated IVH.


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Discussion (DHC without hematoma

evac)

Ramnarayan et al. only 30% of patients had

GCS score 8 or less and hematoma volume

relatively small, the result was favorable

outcomes (65%) and low mortality rate (13%)

Fung et al. hemorrhage or infection

complication occurred in 17% and have

favorable outcomes and mortality rate is 25%


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Conclusion

DHC with hematoma evacuation might be safe

and effective for the treatment of large ICH

The application of only DHC without

hematoma evac for ICH is remains

inconclusive because the small number

reported patients.


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Thank You

decompresive hemicraniectomy

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