Vychopen Martin, Wach Johannes, Lampmann Tim, Asoglu Harun, Vatter Hartmut, Güresir Erdem
Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany.
Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany.
Brain Sci. 2023 Feb 21;13(3):371. doi: 10.3390/brainsci13030371.
Decompressive craniectomy is an option to decrease elevated intracranial pressure in poor-grade aneurysmal subarachnoid hemorrhage (SAH) patients. The aim of the present study was to analyze the size of the bone flap according to approach-related complications in patients with poor-grade SAH. We retrospectively analyzed poor-grade SAH patients (WFNS 4 and 5) who underwent aneurysm clipping and craniectomy (DC or ommitance of bone flap reinsertion). Postoperative CT scans were analyzed for approach-related tissue injury at the margin of the craniectomy (shear bleeding). The size of the bone flap was calculated using the De Bonis equation. Between 01/2012 and 01/2020, 67 poor-grade SAH patients underwent clipping and craniectomy at our institution. We found 14 patients with new shear bleeding lesion in postoperative CT scan. In patients with shear bleeding, the size of the bone flap was significantly smaller compared to patients without shear bleeding (102.1 ± 45.2 cm vs. 150.8 ± 37.43 cm, > 0.0001). However, we found no difference in mortality rates (10/14 vs. 23/53, = 0.07) or number of implanted VP shunts (2/14 vs. 18/53, = 0.2). We found no difference regarding modified Rankin Scale (mRS) 6 months postoperatively. In poor-grade aneurysmal SAH, the initial planning of DC-if deemed necessary -and enlargement of the flap size seems to decrease the rate of postoperatively developed shear bleeding lesions.
减压性颅骨切除术是降低低级别动脉瘤性蛛网膜下腔出血（SAH）患者颅内压升高的一种选择。本研究的目的是根据低级别SAH患者与手术入路相关的并发症分析骨瓣大小。我们回顾性分析了接受动脉瘤夹闭和颅骨切除术（去骨瓣减压术或省略骨瓣回植）的低级别SAH患者（世界神经外科联盟分级4级和5级）。对术后CT扫描进行分析，以评估颅骨切除边缘与手术入路相关的组织损伤（剪切性出血）。使用德博尼斯公式计算骨瓣大小。在2012年1月至2020年1月期间，我们机构有67例低级别SAH患者接受了夹闭和颅骨切除术。我们在术后CT扫描中发现14例患者有新的剪切性出血病变。与无剪切性出血的患者相比，有剪切性出血的患者骨瓣大小明显更小（102.1±45.2平方厘米对150.8±37.43平方厘米，>0.0001）。然而，我们发现死亡率（14例中的10例对53例中的23例，=0.07）或植入脑室腹腔分流术的数量（14例中的2例对53例中的18例，=0.2）没有差异。术后6个月时，改良Rankin量表（mRS）评分没有差异。在低级别动脉瘤性SAH中，如果认为有必要，去骨瓣减压术的初始规划和扩大骨瓣大小似乎可以降低术后发生剪切性出血病变的发生率。
