Decompressive Hemicraniectomy without Evacuation of Acute Intraparenchymal Hemorrhage

Author:

Blanco-Acevedo Cristóbal12,Aguera-Morales Eduardo123ORCID,Fuentes-Fayos Antonio C.245ORCID,Pelaez-Viña Nazareth1,Diaz-Pernalete Rosa6,Infante-Santos Nazaret7ORCID,Muñoz-Jurado Ana24ORCID,Porras-Pantojo Manuel F.6,Ibáñez-Costa Alejandro24ORCID,Luque Raúl M.245ORCID,Solivera-Vela Juan123ORCID

Affiliation:

1. Department of Neurosurgery and Neurology, Reina Sofia University Hospital (HURS), 14004 Cordoba, Spain

2. Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Reina Sofia University, Hospital University of Cordoba, 14004 Cordoba, Spain

3. Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain

4. Department of Cell Biology, Physiology and Immunology, University of Cordoba, 14014 Cordoba, Spain

5. CIBER Physiopathology of Obesity and Nutrition (CIBERobn), 14004 Cordoba, Spain

6. Intensive Care Service, Reina Sofia University Hospital (HURS), 14004 Cordoba, Spain

7. Neurosurgery Service of the Hospital del Mar, 08003 Barcelona, Spain

Abstract

Background: Intracerebral hemorrhages (ICHs) are prevalent, with high morbidity and mortality. We analyzed whether decompressive craniectomy (DC) without evacuation of the acute intraparenchymal hematoma could produce better functional outcomes than treatment with evacuation. Methods: Patients with acute ICH treated with DC without clot evacuation, or evacuation with or without associated craniectomy were included. Matched univariate analyses were performed, and a binary logistic regression model was constructed using the Glasgow Outcome Scale (GOS) and modified Rankin scale (mRS) as dependent variables. Results: 27 patients treated with DC without clot evacuation were compared to 36 patients with clot evacuation; eleven of the first group were matched with 18 patients with evacuation. A significantly better functional prognosis in the group treated with DC without clot evacuation was found. Patients aged < 55 years and treated with DC without clot evacuation had a significantly better functional prognosis (p = 0.008 and p = 0.039, respectively). In multivariate analysis, the intervention performed was the greatest predictor of functional status at the end of follow-up. Conclusions: DC without clot evacuation improves the functional prognosis of patients with acute intraparenchymal hematomas. Larger multicenter studies are warranted to determine whether a change in the management of acute ICH should be recommended.

Funder

Junta de Andalucía

Spanish Ministry of Science, Innovation and Universities

Instituto de Salud Carlos III

European Union

MINECO

CIBERobn

Publisher

MDPI AG

Reference53 articles.

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4. Jakubovic, R., and Aviv, R.I. (2012). Intracerebral Hemorrhage: Toward Physiological Imaging of Hemorrhage Risk in Acute and Chronic Bleeding. Front. Neurol., 3.

5. The Pathophysiology of Intracerebral Hemorrhage Formation and Expansion;Schlunk;Transl. Stroke Res.,2015

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