Outcomes of Decompressive Craniectomy for Spontaneous Deep Supratentorial Intracerebral Hemorrhage

Abstract
Background: Spontaneous Intracerebral Hemorrhage (ICH) is one of the most devastating forms of cerebrovascular disease and is associated with high mortality and morbidity rate. Mass-effects of hematoma and surrounding edema lead to increase intracranial pressure and subsequent brain herni-ation. Decompressive Craniectomy (DC) provide space for the edematous brain to expand away from the midline structures and reduce intracranial pressure.
Aim of Study: The aim of this study was to evaluate the outcome of Outcomes of Decompressive Craniectomy for Spontaneous Deep Supratentorial Intracerebral Hemorrhage.
Patient and Methods: We retrospectively reviewed the medical records of the patients with spontaneous deep su-pratentorial ICH who underwent DC without evacuation of hematoma within 24 hour of ictus. Outcome was assessed by the Glasgow Outcome Scale (GOS) 6 months after surgery.
Results: A total of 12 patients were included in this study. The mean age was 45 years. Mean pre-operative Glasgow Coma Scale (GCS) score was 6.7. Mean hematoma volume was 68ml. At 6 months after surgery, 8 patients (67%) had favorable outcome while 4 (33%) had unfavorable outcome, 2 patients (17%) died. 83% of patients with pre-operative GCS score 8-9 compared to 50% with pre-operative GCS score 5-7 had favorable outcome. 71% of patients with he-matoma volume less than or equal to 70ml compared with 60% with hematoma volume more than 70ml had favorable outcome.
Conclusions: Decompressive craniectomy can be benefi-cial in treatment of spontaneous deep supratentorial ICH in selected patient group. Patients with high pre-operative GCS score and small hematoma volume are more likely to have favorable outcome.