Fabian Wenz, Andreas Ziebart, Katharina A M Hackenberg, Gabriel J E Rinkel, Nima Etminan, Amr Abdulazim
{"title":"动脉瘤性蛛网膜下腔出血所致大面积脑内血肿患者的原发性减压开颅术。","authors":"Fabian Wenz, Andreas Ziebart, Katharina A M Hackenberg, Gabriel J E Rinkel, Nima Etminan, Amr Abdulazim","doi":"10.1007/s00701-024-06221-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Decompressive craniectomy (DC) can alleviate increased intracranial pressure in aneurysmal subarachnoid hemorrhage patients with concomitant space-occupying intracerebral hemorrhage, but also carries a high risk for complications. We studied outcomes and complications of DC at time of ruptured aneurysm repair.</p><p><strong>Methods: </strong>Of 47 patients treated between 2010 and 2020, 30 underwent DC during aneurysm repair and hematoma evacuation and 17 did not. We calculated odds ratios (OR) for delayed cerebral ischemia (DCI), angiographic vasospasm, DCI-related infarction, and unfavorable functional outcome (extended Glasgow Outcome Scale 1-5) at three months. Complication rates after DC and cranioplasty in the aneurysmal subarachnoid hemorrhage patients were compared to those of all 107 patients undergoing DC for malignant cerebral infarction during the same period.</p><p><strong>Results: </strong>In DC versus no DC patients, proportions were for clinical DCI 37% versus 53% (OR = 0.5;95%CI:0.2-1.8), angiographic vasospasm 37% versus 47% (OR = 0.7;95%CI:0.2-2.2), DCI-related infarctions 17% versus 47% (OR = 0.2;95%CI:0.1-0.7) and unfavorable outcome 80% versus 88% (OR = 0.5;95%CI:0.1-3.0). ORs were similar after adjustment for baseline predictors for outcome. Complications related to DC and cranioplasty occurred in 18 (51%) of subarachnoid hemorrhage patients and 41 (38%) of cerebral infarction patients (OR = 1.7;95%CI:0.8-3.7).</p><p><strong>Conclusions: </strong>In patients with aneurysmal subarachnoid hemorrhage and concomitant space-occupying intracerebral hemorrhage, early DC was not associated with improved functional outcomes, but with a reduced rate of DCI-related infarctions. This potential benefit has to be weighed against high complication rates of DC in subarachnoid hemorrhage patients.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11316704/pdf/","citationCount":"0","resultStr":"{\"title\":\"Primary decompressive craniectomy in patients with large intracerebral hematomas due to aneurysmal subarachnoid hemorrhage.\",\"authors\":\"Fabian Wenz, Andreas Ziebart, Katharina A M Hackenberg, Gabriel J E Rinkel, Nima Etminan, Amr Abdulazim\",\"doi\":\"10.1007/s00701-024-06221-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Decompressive craniectomy (DC) can alleviate increased intracranial pressure in aneurysmal subarachnoid hemorrhage patients with concomitant space-occupying intracerebral hemorrhage, but also carries a high risk for complications. We studied outcomes and complications of DC at time of ruptured aneurysm repair.</p><p><strong>Methods: </strong>Of 47 patients treated between 2010 and 2020, 30 underwent DC during aneurysm repair and hematoma evacuation and 17 did not. We calculated odds ratios (OR) for delayed cerebral ischemia (DCI), angiographic vasospasm, DCI-related infarction, and unfavorable functional outcome (extended Glasgow Outcome Scale 1-5) at three months. Complication rates after DC and cranioplasty in the aneurysmal subarachnoid hemorrhage patients were compared to those of all 107 patients undergoing DC for malignant cerebral infarction during the same period.</p><p><strong>Results: </strong>In DC versus no DC patients, proportions were for clinical DCI 37% versus 53% (OR = 0.5;95%CI:0.2-1.8), angiographic vasospasm 37% versus 47% (OR = 0.7;95%CI:0.2-2.2), DCI-related infarctions 17% versus 47% (OR = 0.2;95%CI:0.1-0.7) and unfavorable outcome 80% versus 88% (OR = 0.5;95%CI:0.1-3.0). ORs were similar after adjustment for baseline predictors for outcome. Complications related to DC and cranioplasty occurred in 18 (51%) of subarachnoid hemorrhage patients and 41 (38%) of cerebral infarction patients (OR = 1.7;95%CI:0.8-3.7).</p><p><strong>Conclusions: </strong>In patients with aneurysmal subarachnoid hemorrhage and concomitant space-occupying intracerebral hemorrhage, early DC was not associated with improved functional outcomes, but with a reduced rate of DCI-related infarctions. This potential benefit has to be weighed against high complication rates of DC in subarachnoid hemorrhage patients.</p>\",\"PeriodicalId\":7370,\"journal\":{\"name\":\"Acta Neurochirurgica\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-08-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11316704/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta Neurochirurgica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00701-024-06221-9\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Neurochirurgica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00701-024-06221-9","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:减压开颅术(DC)可以缓解动脉瘤性蛛网膜下腔出血患者同时伴有占位性脑内出血的颅内压增高,但也有很高的并发症风险。我们研究了动脉瘤破裂修补术时 DC 的预后和并发症:在 2010 年至 2020 年间接受治疗的 47 名患者中,30 人在动脉瘤修复和血肿清除期间接受了直流电手术,17 人未接受该手术。我们计算了延迟性脑缺血(DCI)、血管造影血管痉挛、DCI 相关梗死和三个月后不利功能预后(扩展格拉斯哥预后量表 1-5)的几率比(OR)。将动脉瘤性蛛网膜下腔出血患者接受直流手术和颅骨成形术后的并发症发生率与同期因恶性脑梗塞接受直流手术的所有 107 名患者的并发症发生率进行了比较:结果:在接受直流手术和未接受直流手术的患者中,临床DCI比例分别为37%和53%(OR=0.5;95%CI:0.2-1.8),血管痉挛比例分别为37%和47%(OR=0.7;95%CI:0.2-2.2),DCI相关梗死比例分别为17%和47%(OR=0.2;95%CI:0.1-0.7),不良预后比例分别为80%和88%(OR=0.5;95%CI:0.1-3.0)。在对预后的基线预测因素进行调整后,OR 相似。18例(51%)蛛网膜下腔出血患者和41例(38%)脑梗死患者出现了与直流电和开颅手术相关的并发症(OR = 1.7;95%CI:0.8-3.7):对于动脉瘤性蛛网膜下腔出血并同时伴有占位性脑出血的患者,早期DC与功能预后的改善无关,但与DCI相关的脑梗死发生率却有所降低。这一潜在益处必须与蛛网膜下腔出血患者 DC 的高并发症发生率进行权衡。
Primary decompressive craniectomy in patients with large intracerebral hematomas due to aneurysmal subarachnoid hemorrhage.
Background: Decompressive craniectomy (DC) can alleviate increased intracranial pressure in aneurysmal subarachnoid hemorrhage patients with concomitant space-occupying intracerebral hemorrhage, but also carries a high risk for complications. We studied outcomes and complications of DC at time of ruptured aneurysm repair.
Methods: Of 47 patients treated between 2010 and 2020, 30 underwent DC during aneurysm repair and hematoma evacuation and 17 did not. We calculated odds ratios (OR) for delayed cerebral ischemia (DCI), angiographic vasospasm, DCI-related infarction, and unfavorable functional outcome (extended Glasgow Outcome Scale 1-5) at three months. Complication rates after DC and cranioplasty in the aneurysmal subarachnoid hemorrhage patients were compared to those of all 107 patients undergoing DC for malignant cerebral infarction during the same period.
Results: In DC versus no DC patients, proportions were for clinical DCI 37% versus 53% (OR = 0.5;95%CI:0.2-1.8), angiographic vasospasm 37% versus 47% (OR = 0.7;95%CI:0.2-2.2), DCI-related infarctions 17% versus 47% (OR = 0.2;95%CI:0.1-0.7) and unfavorable outcome 80% versus 88% (OR = 0.5;95%CI:0.1-3.0). ORs were similar after adjustment for baseline predictors for outcome. Complications related to DC and cranioplasty occurred in 18 (51%) of subarachnoid hemorrhage patients and 41 (38%) of cerebral infarction patients (OR = 1.7;95%CI:0.8-3.7).
Conclusions: In patients with aneurysmal subarachnoid hemorrhage and concomitant space-occupying intracerebral hemorrhage, early DC was not associated with improved functional outcomes, but with a reduced rate of DCI-related infarctions. This potential benefit has to be weighed against high complication rates of DC in subarachnoid hemorrhage patients.
期刊介绍:
The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.