Decompressive Hemicraniectomy for Massive Cerebral Hemorrhage

Abstract

P103 Background: Hemicraniectomy and durotomy has been shown to be a promising treatment for malignant MCA infarction, but has not been evaluated for cerebral hemorrhage. Methods: We analyzed the clinical course and outcome of 15 patients treated with decompressive surgery for space-occupying cerebral hematomas between 9/98 and 6/00. All patients were treated with duroplasty and either hemicraniectomy (n=13) or a “floating” bone flap (n=2); in some patients, hematoma (n=5) and subdural clot (n=2) evacuation was also performed. Outcomes were assessed by telephone interview using the modified Rankin scale (mRS). Results: Mean age was 49 years (range 33–66); 8 were women; the lesion was left-sided in 7. Hematoma formation was related to spontaneous aneurysmal rupture (n=7), intra-operative aneurysmal rupture (n=3), hypertensive intracerebral hemorrhage (n= 3), and hemorrhagic infarction (n=2). Surgery was peformed Conclusion: Duroplasty and hemicraniectomy, with or without concurrent hematoma evacuation, may improve survival and recovery in comatose patients with large aneurysmal, hypertensive, or infarct-related cerebral hemorrhages.