scholarly journals The Effect of Size of Decompressive Craniectomy on Outcome in Deep Spontaneous Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Sashanka Kode ◽  
Ajay Hegde ◽  
Girish R. Menon
Keyword(s):  
Retrospective Study ◽  
Intracerebral Hemorrhage ◽  
Decompressive Craniectomy ◽  
Surgical Outcome ◽  
Bone Flap ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Mortality And Morbidity ◽  
Hematoma Evacuation

Abstract Introduction Spontaneous intracerebral hemorrhage (SICH) is one of the most devastating forms of stroke with a mortality of 30 to 40%. We aimed to evaluate the effect of craniotomy size and volume of decompression on surgical outcome, complications, mortality, and morbidity in patients with supratentorial capsuloganglionic bleeds who underwent a decompressive craniectomy (DC) at our institute. Materials and Methods It is a retrospective study done between January 2015 and December 2019. All patients with capsuloganglionic bleeds who had DC and hematoma evacuation were included in the study. Results A total of 55 patients underwent DC for SICH at our hospital during the study period. Mean anteroposterior (AP) diameter of the bone flap was 12.42 cm. The volume of decompression did not influence mortality and morbidity in our study but a larger AP diameter was associated with a higher incidence of hydrocephalus. A smaller craniectomy with an AP diameter of < 12 cm caused a lesser reduction in midline shift (MLS). Persistent postoperative MLS had a significant impact on mortality and its reduction was dependent on the size of craniectomy (p =–0.037) Conclusion DC with a recommended AP diameter of 12 to 13 cm achieves optimal results in terms of reduction in MLS. Larger DC volume carries a higher risk of hydrocephalus and requires close follow-up.

Clinical Outcomes and Prognostic Factors for Spontaneous Intracerebral Hemorrhage in Pediatric ICU: A 12-Year Experience

2017 ◽  
Vol 34 (11-12) ◽  
pp. 1003-1009
Author(s):  
Marco Piastra ◽  
Daniele De Luca ◽  
Orazio Genovese ◽  
Federica Tosi ◽  
Francesca Caliandro ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Prognostic Factors ◽  
Intracerebral Hemorrhage ◽  
Clinical Outcomes ◽  
Pediatric Population ◽  
Vegetative State ◽  
Adult Population ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Mortality And Morbidity

Background: In the pediatric population, spontaneous intracerebral hemorrhage (sICH) is as common as ischemic stroke and accounts for significant mortality and morbidity. Differently from the ischemic stroke, there are few guidelines for directing management of sICH. This article aims to analyze both clinical outcomes and prognostic factors in order to produce tools for the design of prospective randomized studies addressed to implement treatment of pediatric sICH. Methods: Twelve-year retrospective review of a single-center consecutivesICH pediatric cases admitted to the pediatric intensive care unit (PICU). Selected end points were survival, PICU stay, and dichotomized Glasgow Outcome Score (GOS), with recovery and moderate disability (GOS 4-5) classified as favorable outcome and vegetative state or severe disability (GOS 2-3) classified as unfavorable. Results: Data of 107 children younger than 14 years admitted to our PICU due to sICH were analyzed. Overall PICU mortality was 24.2%. On multivariate analysis, the single factor markedly influencing survival was the presence of midline shift ( P = .002). In PICU survivors, there were 42 GOS 2-3 and 39 GOS 4-5. A low Glasgow Coma Scale (GCS) on PICU admission was predictive of severe neurological impairment in survivors ( P = .003). Intraventricular hemorrhage and infratentorial origin did not influence outcome in this series. Conclusion: The severity of presentation of sICH expressed by the midline shift and the GCS at PICU admission are significant prognostic factors for survival and neurological outcome. Some prognostic factors of the adult population have not been confirmed.

scholarly journals Endoscopic Surgery Without Decompressive Craniectomy in Large Putaminal Intracerebral Hemorrhage: Assessment of Efficacy and Safety

2019 ◽  
Vol 32 (2) ◽  
pp. 392-399 ◽  
Author(s):  
Yuanliang Ye ◽  
Qiujing Wang ◽  
Weiyang Ou ◽  
Jian He ◽  
Zhenhui Zhao
Keyword(s):  
Mortality Rate ◽  
Intracerebral Hemorrhage ◽  
Decompressive Craniectomy ◽  
Endoscopic Procedure ◽  
Midline Shift ◽  
Multivariate Logistic Regression ◽  
Randomized Controlled ◽  
Group A ◽  
Group B

Abstract Background Decompressive craniectomy (DC) is performed conventionally for large putaminal intracerebral hemorrhage (ICH). However, DC causes local skull defect and leads to post-surgical cranioplasty. The aim of this study is to investigate the effectiveness and safety of an endoscopic procedure to treat large putaminal ICH without DC. Methods This retrospective study included 112 large putaminal ICH patients who underwent hematoma evacuations with either an endoscopic procedure (group A) or with DC (group B) between January 2009 and June 2017. The efficacy was evaluated by mean modified Rankin Scale (mRS) three months after surgery. Safety was evaluated by mortality rate and postoperative complications. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcomes. Results The study included 49 patients in group A and 63 in group B. The mRS scores in both groups were similar after 3 months’ follow-up (p = 0.709). There was no difference in the mortality rate between the two groups (p = 0.538). The rate of complications was lower in group A than that in group B (p = 0.024). Smaller preoperative midline shift (p = 0.008) and absent intraventricular extension (p = 0.044) have contributed significantly to better outcomes. Conclusion Endoscopic hematoma evacuation without DC is safe and effective for patients with large putaminal ICH and deserves further investigation, preferably in a randomized controlled setting.

Decompressive Craniectomy with Hematoma Evacuation for Large Hemispheric Hypertensive Intracerebral Hemorrhage

2013 ◽  
pp. 277-279 ◽  
Author(s):  
Satoru Takeuchi ◽  
Yoshio Takasato ◽  
Hiroyuki Masaoka ◽  
Takanori Hayakawa ◽  
Hiroshi Yatsushige ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Decompressive Craniectomy ◽  
Hematoma Evacuation ◽  
Hypertensive Intracerebral Hemorrhage

The Evaluation of Prognostic Scores in Spontaneous Intracerebral Hemorrhage in an Asian Population: A Retrospective Study

2020 ◽  
Vol 29 (12) ◽  
pp. 105360
Author(s):  
Mervyn Jun Rui Lim ◽  
Arturo Yong Yao Neo ◽  
Gaurav Deep Singh ◽  
Yi Song Terence Liew ◽  
Maehanyi Frances Rajendram ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Intracerebral Hemorrhage ◽  
Asian Population ◽  
Prognostic Scores ◽  
Spontaneous Intracerebral Hemorrhage

scholarly journals Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression

2016 ◽  
Vol 37 (5) ◽  
pp. 1871-1882 ◽  
Author(s):  
Raimund Helbok ◽  
Alois Josef Schiefecker ◽  
Christian Friberg ◽  
Ronny Beer ◽  
Mario Kofler ◽  
...  
Keyword(s):  
Brain Injury ◽  
Intracerebral Hemorrhage ◽  
Electrode Placement ◽  
Secondary Brain Injury ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Strip Electrode ◽  
Hematoma Evacuation ◽  
Perihematomal Edema ◽  
Pathophysiologic Mechanisms

Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3–5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18 patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9–22 min). Postoperative perihematomal-edema progression (85% of patients) was significantly associated with occurrence of isolated and clustered spreading depolarizations. Monitoring of spreading depolarizations may help to better understand pathophysiologic mechanisms of secondary insults after intracerebral hemorrhage. Whether they may serve as target in the treatment of intracerebral hemorrhage deserves further research.

scholarly journals P.104 Peri-cavity atrophy after minimally invasive evacuation of intracerebral hemorrhage

2018 ◽  
Vol 45 (s2) ◽  
pp. S43-S44
Author(s):  
S Ahmed ◽  
J Scaggiante ◽  
J Mocco ◽  
C Kellner
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Surgical Techniques ◽  
Ct Scans ◽  
Cavity Volume ◽  
Cavity Size ◽  
Hematoma Evacuation ◽  
Endoscopic Evacuation ◽  
Invasive Techniques

Background: Intracerebral hemorrhage (ICH) remains a significant cause of morbidity and mortality. While traditional surgical techniques have shown marginal clinical benefit of ICH evacuation, minimally invasive techniques have shown some promise. Endoscopic evacuation of the hemorrhage may reduce the peri-hematoma edema and subsequent atrophy around the hemorrhage cavity. This study aims to quantify the changes in cavity volume following hematoma evacuation. Methods: Patients from the INVEST registry of minimally invasive ICH evacuation were included retrospectively if follow-up computed tomography (CT) scans were available for analysis. Hematoma cavity volumes were calculated from the immediate post-procedural and three-month follow-up CT scans using the Analyze Pro software. Results: Twenty patients had follow-up CT scans at a mean time of 93 days from hematoma evacuation. The average cavity size at follow-up was 11938.12 mm3 (SD: 6996.49). The change in cavity size compared to the prior CT was 6396.74 mm3 (median 2542; range: -1030-27543; SD: 8472.45). This represented mean growth in cavity volume of 54%. Conclusions: This study provides preliminary data describing increase in cavity size after endoscopic minimally invasive evacuation of ICH. Comparison to atrophy in conservatively-managed patients is a further planned avenue of research.

scholarly journals Association Between Alkaline Phosphatase and Clinical Outcomes in Patients With Spontaneous Intracerebral Hemorrhage

2021 ◽  
Vol 12 ◽  
Author(s):  
Sijia Li ◽  
Wenjuan Wang ◽  
Qian Zhang ◽  
Yu Wang ◽  
Anxin Wang ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Adverse Outcomes ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Mortality And Morbidity ◽  
The Third ◽  
Increased Risk

Background: Spontaneous intracerebral hemorrhage (ICH) is associated with high rates of mortality and morbidity. Alkaline phosphatase (ALP) is related to increased risk of cardiovascular events and is also closely associated with adverse outcomes after ischemic or hemorrhagic stroke. However, there are limited data about the effect of ALP on clinical outcomes after ICH. Therefore, we aimed to investigate the relationship between serum ALP level and prognosis in ICH patients.Methods: From January 2014 to September 2016, 939 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. Patients were categorized into four groups based on the ALP quartiles (Q1, Q2, Q3, Q4). The main outcomes were 30-day, 90-day, and 1-year poor functional outcomes (modified Rankin Scale score of 3–6). Multivariable logistic regression and interaction analyses were performed to evaluate the relationships between ALP and clinical outcomes after ICH.Results: In the logistic regression analysis, compared with the third quartile of ALP, the adjusted odds ratios of the Q1, Q2, and Q4 for 30-day poor functional outcome were 1.31 (0.80–2.15), 1.16 (0.71–1.89), and 2.16 (1.32–3.55). In terms of 90-day and 1-year poor functional outcomes, the risks were significantly higher in the highest quartile of ALP compared with the third quartile after adjusting the confounding factors [90-day: highest quartile OR = 1.86 (1.12–3.10); 1-year: highest quartile OR = 2.26 (1.34–3.80)]. Moreover, there was no significant interaction between ALP and variables like age or sex.Conclusions: High ALP level (&gt;94.8 U/L) was independently associated with 30-day, 90-day, and 1-year poor functional outcomes in ICH patients. Serum ALP might serve as a predictor for poor functional outcomes after ICH onset.

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