Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 years
Introduction: Decompressive craniectomy (DC) is a last-tier procedure to lower intracranial pressure in otherwise fatal brain injuries. DC significantly reduces mortality following traumatic brain injury (TBI) and ischemic stroke, but benefits in subarachnoid hemorrhage (SAH) are less clear. Researc...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-01-01
|
| Series: | Brain and Spine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425000220 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823864222113595392 |
|---|---|
| author | Emilia K. Pesonen Aleksi Lammi Cheng Qian Mikael Von und Zu Fraunberg Tommi K. Korhonen Sami Tetri |
| author_facet | Emilia K. Pesonen Aleksi Lammi Cheng Qian Mikael Von und Zu Fraunberg Tommi K. Korhonen Sami Tetri |
| author_sort | Emilia K. Pesonen |
| collection | DOAJ |
| description | Introduction: Decompressive craniectomy (DC) is a last-tier procedure to lower intracranial pressure in otherwise fatal brain injuries. DC significantly reduces mortality following traumatic brain injury (TBI) and ischemic stroke, but benefits in subarachnoid hemorrhage (SAH) are less clear. Research question: We compared the mortality and functional outcomes in patients who underwent DC after SAH with those who underwent DC following TBI or ischemic stroke. Materials and methods: All DC procedures performed in the Oulu University Hospital between January 2009 and December 2019 were retrospectively identified. Mortality and functional outcomes were assessed during a median follow-up of 20.7 months. Extended Glasgow Outcome Scale scores ≥5 were considered favorable. Results: One hundred twenty-four DCs were conducted to patients aged a median of 40 years (SD 16), of whom 88 (71%) were male. Fifty-eight (47%) DCs were due to TBI and 66 (53%) due to stroke. Of the strokes, 41 (62%) were ischemic and 21 (32%) SAH.In multivariate models, the rates of unfavorable outcome were 48% in TBI, 78% in ischemic stroke (OR 2.73, 95% CI 0.70–10.64) and 86% in SAH (OR 3.15, 95%CI 0.67–14.77). Mortality rates were 22% in TBI, 17% in ischemic stroke (OR 0.50, 95%CI 0.11–2.31) and 33% in SAH (OR 0.97, 95%CI 0.24–3.99). Discussion and conclusion: Favorable outcomes were more common in TBI compared to stroke in univariate but not in multivariate analysis. There was no statistically significant difference in the rates of favorable outcomes between SAH and ischemic stroke. |
| format | Article |
| id | doaj-art-28c90935673945ccb6655aa12544848a |
| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-28c90935673945ccb6655aa12544848a2025-02-09T05:01:42ZengElsevierBrain and Spine2772-52942025-01-015104203Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 yearsEmilia K. Pesonen0Aleksi Lammi1Cheng Qian2Mikael Von und Zu Fraunberg3Tommi K. Korhonen4Sami Tetri5Corresponding author. Sairaalanrinne 2b 98, 90220, OULU, Finland.; Department of Neurosurgery, Oulu University Hospital & University of Oulu, Kajaanintie 52, 90029, Oulu, FinlandDepartment of Neurosurgery, Oulu University Hospital & University of Oulu, Kajaanintie 52, 90029, Oulu, FinlandDepartment of Neurosurgery, Oulu University Hospital & University of Oulu, Kajaanintie 52, 90029, Oulu, FinlandDepartment of Neurosurgery, Oulu University Hospital & University of Oulu, Kajaanintie 52, 90029, Oulu, FinlandDepartment of Neurosurgery, Oulu University Hospital & University of Oulu, Kajaanintie 52, 90029, Oulu, FinlandDepartment of Neurosurgery, Oulu University Hospital & University of Oulu, Kajaanintie 52, 90029, Oulu, FinlandIntroduction: Decompressive craniectomy (DC) is a last-tier procedure to lower intracranial pressure in otherwise fatal brain injuries. DC significantly reduces mortality following traumatic brain injury (TBI) and ischemic stroke, but benefits in subarachnoid hemorrhage (SAH) are less clear. Research question: We compared the mortality and functional outcomes in patients who underwent DC after SAH with those who underwent DC following TBI or ischemic stroke. Materials and methods: All DC procedures performed in the Oulu University Hospital between January 2009 and December 2019 were retrospectively identified. Mortality and functional outcomes were assessed during a median follow-up of 20.7 months. Extended Glasgow Outcome Scale scores ≥5 were considered favorable. Results: One hundred twenty-four DCs were conducted to patients aged a median of 40 years (SD 16), of whom 88 (71%) were male. Fifty-eight (47%) DCs were due to TBI and 66 (53%) due to stroke. Of the strokes, 41 (62%) were ischemic and 21 (32%) SAH.In multivariate models, the rates of unfavorable outcome were 48% in TBI, 78% in ischemic stroke (OR 2.73, 95% CI 0.70–10.64) and 86% in SAH (OR 3.15, 95%CI 0.67–14.77). Mortality rates were 22% in TBI, 17% in ischemic stroke (OR 0.50, 95%CI 0.11–2.31) and 33% in SAH (OR 0.97, 95%CI 0.24–3.99). Discussion and conclusion: Favorable outcomes were more common in TBI compared to stroke in univariate but not in multivariate analysis. There was no statistically significant difference in the rates of favorable outcomes between SAH and ischemic stroke.http://www.sciencedirect.com/science/article/pii/S2772529425000220Decompressive craniectomySubarachnoid hemorrhageSAHStrokeTraumatic brain injuryGOSE |
| spellingShingle | Emilia K. Pesonen Aleksi Lammi Cheng Qian Mikael Von und Zu Fraunberg Tommi K. Korhonen Sami Tetri Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 years Brain and Spine Decompressive craniectomy Subarachnoid hemorrhage SAH Stroke Traumatic brain injury GOSE |
| title | Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 years |
| title_full | Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 years |
| title_fullStr | Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 years |
| title_full_unstemmed | Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 years |
| title_short | Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 years |
| title_sort | decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies an institutional experience of 11 years |
| topic | Decompressive craniectomy Subarachnoid hemorrhage SAH Stroke Traumatic brain injury GOSE |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425000220 |
| work_keys_str_mv | AT emiliakpesonen decompressivecraniectomyinsubarachnoidhemorrhagecomparedtootheretiologiesaninstitutionalexperienceof11years AT aleksilammi decompressivecraniectomyinsubarachnoidhemorrhagecomparedtootheretiologiesaninstitutionalexperienceof11years AT chengqian decompressivecraniectomyinsubarachnoidhemorrhagecomparedtootheretiologiesaninstitutionalexperienceof11years AT mikaelvonundzufraunberg decompressivecraniectomyinsubarachnoidhemorrhagecomparedtootheretiologiesaninstitutionalexperienceof11years AT tommikkorhonen decompressivecraniectomyinsubarachnoidhemorrhagecomparedtootheretiologiesaninstitutionalexperienceof11years AT samitetri decompressivecraniectomyinsubarachnoidhemorrhagecomparedtootheretiologiesaninstitutionalexperienceof11years |