Decompressive Craniectomy in Addition to Hematoma Evacuation Improves Mortality of Patients with Spontaneous Basal Ganglia Hemorrhage

We conducted a retrospective study to assess the effect of decompressive craniectomy on outcome of patients with spontaneous basal ganglia hemorrhage (SBH). A review of a hospital database was performed to search for patients with a diagnosis of SBH who received hematoma evacuation with (N=38) or without (N=46) decompressive craniectomy in our institute from January 2005 to January 2008. Descriptive statistics revealed that patients in the decompressive craniectomy group were in poorer clinical condition before surgery. Unadjusted analyses found no significant difference between groups in either 30-day mortality or 6-month functional survival (32% v 43%, P=.26, and 55% v 45%, P=.28, respectively). However, after severity adjustment the multivariate logistic regression analysis showed that decompressive craniectomy group was associated with improved 30-day mortality (Exp (B) 0.11, 95% confidence interval 0.02-0.60, P=.01) and 6-month functional survival (Exp (B) 26.97, 95% confidence interval 2.20-317.62, P=.01). In conclusion, our study suggests decompressive craniectomy in addition to hematoma evacuation might improve mortality of deteriorating patients with SBH. Larger, randomized studies are needed to verify this result.

Key Words: Intracerebral hemorrhage, decompressive craniectomy, mortality, brain edema