Quig Nathan, Shastri Darshan, Zeitouni Daniel, Yap Edward, Sasaki-Adams Deanna
Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA.
Cureus. 2021 Sep 17;13(9):e18057. doi: 10.7759/cureus.18057. eCollection 2021 Sep.
Decompressive hemicraniectomy (DCHC) may be indicated in the setting of subarachnoid hemorrhage (SAH) complicated by persistent elevated intracranial pressure (ICP) that is refractory to medical interventions. Outcomes can be variable as indications for surgery can include focal hematomas, infarctions, and regional or diffuse edema. Bilateral DCHC for medically refractory elevated ICP in the setting of SAH is not well described in the literature, and the viability of this option in terms of patient outcomes is unclear. We describe the cases of four patients with medically refractory ICP secondary to diffuse cerebral edema who underwent bilateral DCHC in the setting of SAH. This is a retrospective case review of four patients with aneurysmal SAH who underwent bilateral DCHC for management of diffuse global edema resulting in medically refractory ICP. We describe two patients who made impressive recoveries after bilateral DCHC and two patients who required significant continued care needs despite ICP control in all patients. Bilateral DCHC is a viable option for control of refractory elevated ICP in SAH patients who develop diffuse cerebral edema. Bilateral DCHC in this setting can be considered after exhaustion of other therapeutic options.
减压性颅骨切除术（DCHC）可能适用于蛛网膜下腔出血（SAH）并发持续性颅内压（ICP）升高且对药物治疗无效的情况。由于手术指征可能包括局灶性血肿、梗死以及局部或弥漫性水肿，其结果可能各不相同。对于SAH情况下药物治疗无效的ICP升高，双侧DCHC在文献中描述较少，该选择对患者预后的可行性尚不清楚。我们描述了4例因弥漫性脑水肿导致药物治疗无效的ICP升高且在SAH情况下接受双侧DCHC的患者病例。这是对4例动脉瘤性SAH患者进行的回顾性病例分析，这些患者接受双侧DCHC以治疗导致药物治疗无效的ICP升高的弥漫性全脑水肿。我们描述了2例双侧DCHC后恢复良好的患者，以及2例尽管所有患者的ICP均得到控制但仍需要大量持续护理的患者。双侧DCHC是控制SAH患者因弥漫性脑水肿导致的难治性ICP升高的可行选择。在其他治疗选择用尽后，可以考虑在这种情况下进行双侧DCHC。
