Pedro Karlo M, Chua Annabell E, Lapitan Marie Carmela M
Section of Neurosurgery, Department of Neurosciences, University of the Philippines-Manila, Philippine General Hospital.
Section of Neurosurgery, Department of Neurosciences, University of the Philippines-Manila, Philippine General Hospital.
Clin Neurol Neurosurg. 2020 May;192:105730. doi: 10.1016/j.clineuro.2020.105730. Epub 2020 Feb 7.
Decompressive hemicraniectomy (DH) effectively alleviates increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI) and malignant middle cerebral artery (MCA) infarction. Its role in the management of spontaneous intracranial hemorrhage (SICH) however remains uncertain. This study aims to review the efficacy and safety of DH without clot evacuation in SICH.
A systematic literature search of PubMEd, EMBASE, Scopus and Cochrane Library Central Register of Control Trials was performed. Studies were reviewed independently for methodology, inclusion and exclusion criteria and end points. Primary endpoint was overall mortality. Secondary endpoint was functional outcome using modified Rankin scale (mRs) or Glasgow outcome scale (GOS).
Nine studies with a total of 146 patients who underwent DH without clot evacuation include: 1 RCT, 3 cohort, 2 case series, and 3 case-control studies. Age range was 40-60 years, with majority of patients presenting with a relatively depressed preoperative sensorium (GCS 6-8), large hematoma volumes (>50 mL), and deep locations (basal ganglia and thalamus). Pooled analysis showed a favorable outcome in 53 %, a mortality rate of 26 % and a complication rate of 35.8 %.
DH without clot evacuation may offer functional and mortality benefit in patients with spontaneous ICH, based on limited and heterogeneous studies.
减压性颅骨切除术（DH）可有效缓解创伤性脑损伤（TBI）和恶性大脑中动脉（MCA）梗死患者颅内压（ICP）升高的情况。然而，其在自发性颅内出血（SICH）治疗中的作用仍不明确。本研究旨在回顾不进行血块清除的减压性颅骨切除术在自发性颅内出血治疗中的疗效和安全性。
对PubMed、EMBASE、Scopus和Cochrane图书馆对照试验中央注册库进行了系统的文献检索。对研究的方法、纳入和排除标准以及终点进行了独立审查。主要终点是总死亡率。次要终点是使用改良Rankin量表（mRs）或格拉斯哥预后量表（GOS）评估的功能结局。
9项研究共纳入146例行减压性颅骨切除术且未进行血块清除的患者，包括：1项随机对照试验、3项队列研究、2项病例系列研究和3项病例对照研究。年龄范围为40 - 60岁，大多数患者术前意识相对淡漠（格拉斯哥昏迷量表评分6 - 8分），血肿体积较大（>50 mL），且位于深部（基底节和丘脑）。汇总分析显示，53%的患者预后良好，死亡率为26%，并发症发生率为35.8%。
基于有限且异质性的研究，不进行血块清除的减压性颅骨切除术可能对自发性脑出血患者的功能和死亡率有益。
