Goedemans Taco, Verbaan Dagmar, Coert Bert A, Kerklaan Bertjan J, van den Berg René, Coutinho Jonathan M, van Middelaar Tessa, Nederkoorn Paul J, Vandertop William Peter, van den Munckhof Pepijn
Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, and Zaans Medical Center, Zaandam, The Netherlands.
World Neurosurg. 2017 Sep;105:765-774. doi: 10.1016/j.wneu.2017.06.069. Epub 2017 Jun 20.
Decompressive craniectomy (DC) has been proposed as a lifesaving treatment in patients with elevated intracranial pressure, but its effectiveness on reaching a favorable neurologic outcome remains unclear. We identified predictors of outcome in a large, single-center cohort of patients undergoing DC for different pathologic conditions.
This retrospective study included all patients undergoing DC from 2006 to 2014. The 1-year outcome, assessed using the Glasgow Outcome Scale (GOS), was dichotomized into favorable (GOS 4-5) and unfavorable (GOS 1-3) outcome. Predictors of outcome were identified by analyzing patient characteristics.
DC was performed in 204 patients for ischemic stroke (n = 57), traumatic brain injury (n = 50), aneurysmal subarachnoid hemorrhage (aSAH) (n = 44), intracerebral hemorrhage (ICH) (n = 29), cerebral venous thrombosis (CVT) (n = 14), or other indications (n = 10). Overall, 69 (34%) patients survived favorably, 39 (19%) survived unfavorably, and 96 (47%) died. Higher age, poor Glasgow Coma Scale score, intubated status before DC, bilateral absence of pupillary light reflexes, DC for aSAH, and additional surgeries after DC (excluding cranioplasty) were significant predictors of unfavorable outcome. When patients were sorted for pathologic conditions and predictors of outcome, favorable outcome rates differed remarkably, ranging from 91% for CVT patients undergoing uncomplicated DC to 0% for aSAH patients undergoing DC for secondary infarction or ICH patients with unilateral or bilateral abnormal pupillary light reflexes upon admission.
Long-term neurologic outcome after DC differed remarkably among subpopulations of patients, with favorable outcome rates ranging from 0% to >90%.
去骨瓣减压术（DC）已被提议作为颅内压升高患者的一种挽救生命的治疗方法，但其对实现良好神经功能结局的有效性仍不明确。我们在一个大型单中心队列中，针对因不同病理状况接受DC治疗的患者，确定了结局的预测因素。
这项回顾性研究纳入了2006年至2014年期间所有接受DC治疗的患者。使用格拉斯哥预后量表（GOS）评估的1年结局被分为良好（GOS 4 - 5）和不良（GOS 1 - 3）结局。通过分析患者特征来确定结局的预测因素。
204例患者接受了DC治疗，病因包括缺血性卒中（n = 57）、创伤性脑损伤（n = 50）、动脉瘤性蛛网膜下腔出血（aSAH）（n = 44）、脑出血（ICH）（n = 29）、脑静脉血栓形成（CVT）（n = 14）或其他适应证（n = 10）。总体而言，69例（34%）患者获得良好生存，39例（19%）患者生存但预后不良，96例（47%）患者死亡。年龄较大、格拉斯哥昏迷量表评分较低、DC术前插管状态、双侧瞳孔对光反射消失、因aSAH行DC以及DC术后进行额外手术（不包括颅骨修补术）是不良结局的显著预测因素。当根据病理状况和结局预测因素对患者进行分类时，良好结局率差异显著，从接受简单DC治疗的CVT患者的91%到因继发性梗死接受DC治疗的aSAH患者或入院时单侧或双侧瞳孔对光反射异常的ICH患者的0%不等。
DC术后的长期神经功能结局在不同亚组患者中差异显著，良好结局率从0%到>90%不等。
