Department of Neurosurgery (L.L., V.A.M., S.C.S., M.Z., M.A.H., J.D.G., D.M.H., E.C.L.), University of Iowa.
Department of Neurology (E.C.L.), University of Iowa.
Stroke. 2021 Mar;52(3):1105-1108. doi: 10.1161/STROKEAHA.120.032224. Epub 2021 Jan 28.
Decompressive hemicraniectomy has been used to treat spontaneous intracerebral hemorrhage, but the benefit of evacuating the hematoma during the procedure is unclear. We aim to evaluate the utility of performing clot evacuation during hemicraniectomy for spontaneous intracerebral hemorrhage.
Retrospective cohort of consecutive patients (2010-2019) treated with decompressive hemicraniectomy for a spontaneous supratentorial intracerebral hemorrhage at the University of Iowa. We compared hemicraniectomy alone to hemicraniectomy plus hematoma evacuation. We analyzed clinical features and hematoma characteristics. The outcomes at 6 months were dichotomized into unfavorable (Glasgow Outcome Scale score 1-3) and favorable (Glasgow Outcome Scale score 4-5).
Eighty-three patients underwent decompressive hemicraniectomy for spontaneous intracerebral hemorrhage, 52 with hematoma evacuation, and 31 without hematoma evacuation. There were no statistically significant differences in clinical and radiographic characteristics between the 2 groups. Evacuating the hematoma in addition to hemicraniectomy did not change the odds of favorable outcome at 6 months (=0.806).
In this retrospective study, the performance of hematoma evacuation during decompressive hemicraniectomy for spontaneous intracerebral hemorrhage may not change functional outcomes over performing the hemicraniectomy alone.
去骨瓣减压术已被用于治疗自发性脑出血，但在手术过程中清除血肿的益处尚不清楚。我们旨在评估在自发性幕上脑出血行去骨瓣减压术中进行血栓清除的效用。
回顾性连续患者队列（2010-2019 年），在爱荷华大学接受自发性幕上脑出血去骨瓣减压术治疗。我们比较了单纯去骨瓣减压术与去骨瓣减压术加血肿清除术。我们分析了临床特征和血肿特征。6 个月时的结局分为不良（格拉斯哥预后量表评分 1-3）和良好（格拉斯哥预后量表评分 4-5）。
83 例患者因自发性脑出血而行去骨瓣减压术，其中 52 例行血肿清除术，31 例行血肿清除术。两组的临床和影像学特征无统计学差异。除了去骨瓣减压术之外，清除血肿并不能改变 6 个月时的良好结局的几率（=0.806）。
在这项回顾性研究中，在自发性脑出血行去骨瓣减压术中进行血肿清除可能不会改变单独行去骨瓣减压术的功能结局。
