Decompressive craniectomy for spontaneous intracerebral hematoma, does it add benefit?

ABSTRACT

Background: Many studies discussed the validity of hematoma evacuation versus conservative treatment, and little research discussed the role of decompressive craniectomy in the management of SICH. The purpose of the study is to discuss the role of decompressive craniectomy alone in selected cases of supratentorial SICH and comparing it with the reported results of best medical treatment in the literatures. Patients and methods; Fourteen patients harboring SICH with mass effect were operated in Zagazig University Hospitals by decompressive craniectomy from March 2015 to September 2017. Inclusion criteria were hypertensive supratentorial SICH with massive edema and midline shift and GCS score below 10. Wide decompressive craniotomy was performed together with duroplasty. Patients were followed for 6 months postoperatively using modified Rankin scale (mRS). Results: There was 14 patients, 9 males and 5 females with mean age 69.7 (range 56 to 81), 8 right and 6 left sided hematoma with mean GCS of 7 (range 4 to 10), preoperative midline shift ranged from 9 mm to 15 mm (mean 12.7). Early postoperative follow up showed improvement of GCS mean 11 (range 6 to 15) and midline shift mean 3 mm (range 1 to 9) in the first 24 hours. At 6 months, mortality rate was 2/14. GOS showed good outcome (mRS 0-4) in 10 patients and poor outcome (mRS 5-6) in 4 patients. Conclusion: Decompressive craniectomy with duroplasty is an effective method for management of supratentorial SICH and is better than the best medical treatment in selected cases