Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Neurosurg Focus. 2013 May;34(5):E3. doi: 10.3171/2013.2.FOCUS12422.
Surgical evacuation of nontraumatic, supratentorial intracerebral hemorrhage (SICH) is uncommonly performed, and outcomes are generally poor. On the basis of published experimental data and the authors' anecdotal observations, a retrospective chart review study was performed to test the hypothesis that large decompressive craniectomies (DCs), compared with craniotomies, would improve clinical outcomes after surgical evacuation of SICH. For patients with putaminal SICH, DC was associated with a statistically significant improvement in midline shift, compared with craniotomy. Decompressive craniectomies also resulted in a strong trend toward decreased likelihood of poor neurological outcome (modified Rankin Scale score > 3). For patients with lobar SICH, no associations were found between DC or craniotomy and clinical outcomes. For patients selected to undergo surgical evacuation of putaminal SICH, a DC in addition to surgical evacuation of the hematoma might improve outcome.
非创伤性幕上脑内出血（SICH）的手术清除并不常见，且结果通常较差。基于已发表的实验数据和作者的经验观察，进行了一项回顾性图表审查研究，以检验以下假设：与开颅术相比，大骨瓣减压术（DC）可改善 SICH 手术后的临床结果。对于壳核 SICH 患者，与开颅术相比，DC 可显著改善中线移位。减压性颅骨切除术也使不良神经结局（改良 Rankin 量表评分>3）的可能性降低。对于脑叶 SICH 患者，未发现 DC 或开颅术与临床结果之间存在关联。对于选择接受壳核 SICH 手术清除的患者，除血肿清除外，行 DC 可能会改善预后。
