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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2022; 11(01): 049-054
DOI: 10.1055/s-0041-1730102
Original Article

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

Sashanka Kode
1   Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
2   Department of Neurosurgery, Nizams Institute of Neurosciences, Hyderabad, Telangana, India
,
Ajay Hegde 
1   Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
3   Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
,
Girish R. Menon 
1   Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
› Author Affiliations Funding None. Note: ½ABC is the formula used to measure the volume gained, where A denotes the diameter, B the perpendicular line, and C the height. Note: In the expression ABC/2, A and B are the perpendicular maximal diameters of the lesion and C is the total length in the vertical plane. Note: In the expression ABC/2, A and B are the perpendicular maximal diameters of the lesion and C is the total length in the vertical plane.
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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.

Keywords

decompressive craniectomy - spontaneous intracerebral hemorrhage - stroke - mRs - surgical outcome


Publication History

Article published online:
24 November 2021

© 2021. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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