Academic literature on the topic 'Decompressive hemicraniectomy (DHC)'
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Journal articles on the topic "Decompressive hemicraniectomy (DHC)"
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Hecht, Nils, Hermann Neugebauer, Ingo Fiss, Alexandra Pinczolits, Peter Vajkoczy, Eric Jüttler, and Johannes Woitzik. "Infarct volume predicts outcome after decompressive hemicraniectomy for malignant hemispheric stroke." Journal of Cerebral Blood Flow & Metabolism 38, no. 6 (June 30, 2017): 1096–103. http://dx.doi.org/10.1177/0271678x17718693.
Full textAbstract:
The decision to perform decompressive hemicraniectomy (DHC) by default in malignant hemispheric stroke (MHS) remains controversial. Even under ideal conditions, DHC usually results in moderate to severe disability. The present study for the first time uses neuroimaging to identify independent outcome predictors in a prospective cohort of 96 MHS patients undergoing DHC. The primary outcome was functional status according to the modified Rankin Scale (mRS) at 12 months and categorized as favorable (mRS 0–3) or unfavorable (mRS 4–6). At 12 months, 19 patients (20%) reached favorable and 77 patients (80%) unfavorable outcome. The overall mean infarct volume was 328 ± 114 ml. Multivariable logistic regression identified age per year (OR 1.14, 95% CI 1.04–1.24; p = 0.005), infarct volume per cm3 (OR 1.012, 95% CI 1.003–1.022; p = 0.013), thalamic involvement (OR 8.65, 95% CI 1.04–72.15; p = 0.046) and postoperative pneumonia (OR 5.52, 95% CI 1.03–29.57; p = 0.046) as independent outcome predictors, which was confirmed by multivariable ordinal regression for age ( p = 0.004) and infarct volume ( p = 0.015). The infarct volume threshold for reasonable prediction of unfavorable outcome in our patients was 270 cm3, which in the future may help prognostication and development of clinical trials on DHC and outcome in MHS.
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Joarder, MA, AKMB Karim, T. Kamal, T. Sujon, N. Akhter, K. Islam, MZ Hossain, et al. "Retrospective comparison of decompressive hemicraniectomy and hematoma evacuation for spontaneous supratentorial intracerebral hematoma." Pulse 7, no. 1 (May 7, 2015): 16–21. http://dx.doi.org/10.3329/pulse.v7i1.23245.
Full textAbstract:
Objectives: The aim of this study was to test the hypothesis that decompressive hemicraniectomy (DHC), compared with craniotomy with evacuation of hematoma, and would improve clinical outcomes of patients with supratentorial intracerebral hemorrhage (SICH).Methods: We compared patients (November 2008February 2014) with supratentorial ICH treated with DHC without hematoma evacuation and craniotomy with hematoma evacuation. DHC measured at least 150 mm and included opening of the dura. We analyzed clinical, radiological, and surgical characteristics. Outcome at 6 months was divided into good (modified Rankin Scale 04) and poor (modified Rankin Scale 56).Results: Fifteen patients (mean age 58 years) with ICH were treated by DHC. Median hematoma volume was 61 ml and mean preoperative Glasgow Coma Scale (GCS) was 7. Ten patients had good and five had poor outcomes. In hematoma evacuation group 29 patients were treated. Median hematoma volume was 55 ml and mean preoperative Glasgow Coma Scale (GCS) was 8. Seventeen patients had good and twelve had poor outcomes.Conclusions: DHC is more effective than hematoma evacuation in patients with SICH. Based on this small cohort, DHC may reduce mortality. Larger prospective study is warranted to assess safety and efficacy.Pulse Vol.7 January-December 2014 p.16-21
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Youssef, Omar, Taher M. Ali, Khaled Anbar, Osama El-Shahawy, and Abdelrhman Enayet. "Value of Adding Cisternostomy to Decompressive Hemicraniectomy in the Management of Traumatic Acute Subdural Hematoma Patients." Open Access Macedonian Journal of Medical Sciences 8, B (July 31, 2020): 1014–22. http://dx.doi.org/10.3889/oamjms.2020.4423.
Full textAbstract:
BACKGROUND: Surgical evacuation of acute subdural hematoma has remained the mainstay of the treatment for acute subdural hematoma (ASDH) in patients with progressive neurological deficits, increasing intracranial pressure (ICP), or significant mass effect. Cisternostomy entails opening the basal cisterns aiming to their opening to atmospheric pressure and therefore reducing the intraparenchymal pressure.
AIM: We aimed to evaluate value of adding cisternostomy to decompressive craniotomy on outcome of traumatic ASDH patients.
METHODS: Prospective study included 40 patients who presented to Cairo University hospital emergency department with traumatic acute subdural hematoma in the period between January 2018 and June 2019 and matching our inclusion criteria: Age from 12 to 65 years, traumatic acute subdural hematoma with thickness ≥ 10 mm or midline shift ≥ 5 mm, and Glasgow Coma Scale (GCS) on admission < 10, with no associated intraparenchymal hematoma ≥ 1 cm or severe comorbidities. Patients were randomized into one of two groups according to their order of coming. The first group patients were operated on by decompressive craniotomy (DHC) plus cisternostomy and the second group was operated on by decompressive craniotomy only. Glasgow Outcome Score (GOS) was used for outcome assessment.
RESULTS: Outcome was better 2nd but not statistically significant – in the first group (DHC+ cisternostomy) in terms of mortality: 7/20 patients (35%) (p = 0.337) and median GOS: 3 (p = 0.337), compared to the second group (DHC only) in which mortality occurred in 10/20 (50%) and median GOS was 1. Adding cisternostomy to decompressive craniotomy increased surgery time with 35.5 minutes in average. In our study, older age and lower GCS on admission had significantly worse outcome.
CONCLUSION: Adding cisternostomy to decompressive craniotomy in traumatic patients had better 2nd but not statistically significant outcome. Whether it should replace the routine decompressive craniotomy in these cases or not needs further larger clinical trials.
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Joarder, Md Aliuzzaman, AKM Bazlul Karim, Shariful Islam Sujon, Nahid Akhter, Md Waheeduzzaman, Dorai Raj Krupa Shankar, Salim Mohammad Jahangir, and Mathew J. Chandy. "Decompressive Hemicraniectomy in Hypertensive Basal Ganglia Hemorrhages." Pulse 8, no. 1 (June 6, 2016): 38–42. http://dx.doi.org/10.3329/pulse.v8i1.28100.
Full textAbstract:
Objectives: The aim of this study was to analyze efficacy and safety of decompressive hemicraniectomy (DHC) in hypertensive basal ganglia hemorrhage (HBGH). Neurosurgical management of HBGH is still a controversial issue. Surgical techniques are diverse, from the open large craniotomy, to the minimally invasive techniques like stereotactic aspiration of the HBGH, endoscopic evacuation and stereotactic catheter drainage after instillation of thrombolytic agents. Decompressive hemicraniectomy lowers intracranial pressure and improves outcome in patients with HBGH.Methods: 8 patients with HBGH who underwent decompressive craniectomy in the last 2 years were analyzed. Parameters investigated included clinical presentations, radiologic profile, time interval from ictus to surgery, and modified Rankin Scale score at 6 months.Results: The patients mean age 55 years, the mean Glasgow Coma Scale (GCS) score was 7 (range 513), the mean ICH volume was 58 ml (range 4070 ml), and the mean midline shift was 10.62 mm (range 6-16 mm). The outcome after 6 months was appreciated as good (modified Rankin Scale 04) or poor (modified Rankin Scale 5-6). Five patients had good and three had poor outcomes (including two deaths).Conclusion: We conclude, based on this small cohort, that DC can reduce mortality in some cases. Larger prospective studies are needed to assess safety and efficacy of this method.Pulse Vol.8 January-December 2015 p.38-42
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Neugebauer, Hermann, Ingo Fiss, Alexandra Pinczolits, Nils Hecht, Jens Witsch, Nora F. Dengler, Peter Vajkoczy, Eric Jüttler, and Johannes Woitzik. "Large Size Hemicraniectomy Reduces Early Herniation in Malignant Middle Cerebral Artery Infarction." Cerebrovascular Diseases 41, no. 5-6 (2016): 283–90. http://dx.doi.org/10.1159/000443935.
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Background: Decompressive hemicraniectomy (DHC) reduces mortality and improves outcome after malignant middle cerebral artery infarction (MMI) but early in-hospital mortality remains high between 22 and 33%. Possibly, this circumstance is driven by cerebral herniation due to space-occupying brain swelling despite decompressive surgery. As the size of the removed bone flap may vary considerably between surgeons, a size too small could foster herniation. Here, we investigated the effect of the additional volume created by an extended DHC (eDHC) on early in-hospital mortality in patients suffering from MMI. Methods: We performed a retrospective single-center cohort study of 97 patients with MMI that were treated either with eDHC (n = 40) or standard DHC (sDHC; n = 57) between January 2006 and June 2012. The primary study end point was defined as in-hospital mortality due to transtentorial herniation. Results: In-hospital mortality due to transtentorial herniation was significantly lower after eDHC (0 vs. 11%; p = 0.04), which was paralleled by a significantly larger volume of the craniectomy (p < 0.001) and less cerebral swelling (eDHC 21% vs. sDHC 25%; p = 0.03). No statistically significant differences were found in surgical or non-surgical complications and postoperative intensive care treatment. Conclusion: Despite a more aggressive surgical approach, eDHC may reduce early in-hospital mortality and limit transtentorial herniation. Prospective studies are warranted to confirm our results and assess general safety of eDHC.
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Barrientos, Ricardo, Carlos Sisniega, Samanta Catueno, Robin Hougen, Ashley Hanna, and Utpal Bhalala. "Decompressive Hemicraniectomy and Favorable Outcome in a Pediatric Patient with Malignant Middle Cerebral Artery Infarction." Case Reports in Pediatrics 2022 (September 13, 2022): 1–5. http://dx.doi.org/10.1155/2022/6500488.
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We report a rare case of middle cerebral artery (MCA) stroke in a teenage girl with initial improvement, followed by progression to malignant MCA infarction, requiring an urgent decompressive hemicraniectomy (DHC). Additionally, we report improvement in all areas, including language, comprehension, and motor skills at discharge and the 4-month follow-up. This rare presentation highlights the importance of monitoring the neurological status of a patient with an MCA infarct for progression to a life-threatening malignant MCA infarct. This case report also highlights the importance of consideration of DHC for a favorable outcome of the MMCA infarction.
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Ghulam, Naseeruddin, Kashif Ali Sultan, Mohammad Ashraf, Nabeel Choudhary, Usman Ahmad Kamboh, Nazir Ahmad, Muhammad Asif Raza, Waqa Latif, Syed Shahzad Hussain, and Naveed Ashraf. "Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country." Pakistan Journal Of Neurological Surgery 25, no. 4 (January 19, 2022): 537–49. http://dx.doi.org/10.36552/pjns.v25i4.606.
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Objective: To evaluate the prognostic factors affecting functional clinical outcomes in severe traumatic brain injury patients with traumatic mass lesions undergoing decompressive hemicraniectomy (DHC).
Materials and Methods: A prospective cohort of 85 patients of severe traumatic brain injury patients with traumatic mass lesions underwent a unilateral decompressive hemicraniectomy. Functional outcomes were assessed using the Glasgow Outcome Score at 28 days, 3 months, and 6 months. Bivariate analysis (chi-squared) was used to identify parameters that resulted in poor outcomes and multiple regression was used to identify independent factors predicting poor outcomes.
Results: 85 patients were recruited. Functional outcomes were dichotomised as favourable (Glasgow Outcome Score of 4 – 5) and poor (Glasgow Outcome Score 1-3) and evaluated at 28 days, 3 and 6 months. A total of 59 patients expired (69.4%). Bivariate analysis revealed GCS 3 – 5 at presentation (P = 0.002), midline shift greater than 7.5mm (P < 0.001), the volume of the mass lesion more than 40ml (P = 0.006) resulted in a poor outcome. Age dichotomised to less than or more than 50 years bordered statistical significance (P = 0.063). Only GCS at presentation and midline shift were independent factors that predicted poor outcomes when controlling for covariates.
Conclusion: Decompressive hemicraniectomy can be a lifesaving intervention in managing severe traumatic brain injury patients with traumatic mass lesions. However, its use needs to be employed judiciously.
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Kamran, Saadat, Naveed Akhtar, Abdul Salam, Ayman Alboudi, Kainat Kamran, Arsalan Ahmed, Rabia A. Khan, Mohsin K. Mirza, Jihad Inshasi, and Ashfaq Shuaib. "Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate." Stroke Research and Treatment 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/2507834.
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Objective and Methods.The outcome in late decompressive hemicraniectomy in malignant middle cerebral artery stroke and the optimal timings of surgery has not been addressed by the randomized trials and pooled analysis. Retrospective, multicenter, cross-sectional study to measure outcome following DHC under 48 or over 48 hours using the modified Rankin scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4 at three months.Results.In total, 137 patients underwent DHC. Functional outcome analyzed as mRS 0–4 versus mRS 5-6 showed no difference in this split between early and late operated on patients [P=0.140] and mortality [P=0.975]. Multivariate analysis showed that age ≥ 55 years, MCA with additional infarction, septum pellucidum deviation ≥1 cm, and uncal herniation were independent predictors of poor functional outcome at three months. In the “best” multivariate model, second infarct growth rate [IGR2] >7.5 ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] and second infarct growth rate [IGR2] were nearly double [P<0.001] in patients with early surgery [under 48 hours].Conclusions.The outcome and mortality in malignant middle cerebral artery stroke patients operated on over 48 hours of stroke onset were comparable to those of patients operated on less than 48 hours after stroke onset. Our data identifies IGR, temporal lobe involvement, and middle cerebral artery with additional infarct as independent predictors for early surgery.
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Heuts, Simon G., Samuel S. Bruce, Brad E. Zacharia, Zachary L. Hickman, Christopher P. Kellner, Eric S. Sussman, Michael M. McDowell, Rachel A. Bruce, and E. Sander Connolly. "Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis." Neurosurgical Focus 34, no. 5 (May 2013): E4. http://dx.doi.org/10.3171/2013.2.focus1326.
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Object Large intracerebral hemorrhage (ICH), compounded by perihematomal edema, can produce severe elevations of intracranial pressure (ICP). Decompressive hemicraniectomy (DHC) with or without clot evacuation has been considered a part of the armamentarium of treatment options for these patients. The authors sought to assess the preliminary utility of DHC without evacuation for ICH in patients with supratentorial, dominant-sided lesions. Methods From September 2009 to May 2012, patients with ICH who were admitted to the neurological ICU at Columbia University Medical Center were prospectively enrolled in that institution's ICH Outcomes Project (ICHOP). Five patients with spontaneous supratentorial dominant-sided ICH underwent DHC without clot evacuation for recalcitrant elevated ICP. Data pertaining to the patients' characteristics and outcomes of treatment were prospectively collected. Results The patients' median age was 43 years (range 30–55 years) and the ICH etiology was hypertension in 4 of 5 patients, and systemic lupus erythematosus vasculitis in 1 patient. On admission, the median Glasgow Coma Scale (GCS) score was 7 (range 5–9). The median ICH volume was 53 cm3 (range 28–79 cm3), and the median midline shift was 7.6 mm (range 3.0–11.3 mm). One day after surgery, the median decrease in midline shift was 2.7 mm (range 1.5–4.6 mm), and the median change in GCS score was +1 (range −3 to +5). At discharge, all patients were still alive, and the median GCS score was 10 (range 9–11), the median modified Rankin Scale (mRS) score was 5 (range 5–5), and the median NIHSS (National Institutes of Health Stroke Scale) score was 22 (range 17–27). Six months after hemorrhage, 1 patient had died, 2 were functionally dependent (mRS Score 4–5), and 2 were functionally independent (mRS Score 0–3). Outcomes for the patients treated with DHC were good compared with 1) outcomes for all patients with spontaneous supratentorial ICH admitted during the same period (n = 144) and 2) outcomes for matched patients (dominant ICH, GCS Score 5–9, ICH volume 28–79 cm3, age < 60 years) whose cases were managed nonoperatively (n = 5). Conclusions Decompressive hemicraniectomy without clot evacuation appears feasible in patients with large ICH and deserves further investigation, preferably in a randomized controlled setting.
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Koirala, Sagar, Shreeram Bhandari, and Subash Lohani. "Factors affecting outcome of decompressive hemicraniectomy in malignant middle cerebral artery infarction." Nepal Journal of Neuroscience 18, no. 3 (September 1, 2021): 35–38. http://dx.doi.org/10.3126/njn.v18i3.37109.
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Introduction: Decompressive Hemicraniectomy (DHC) is a standard surgical management of malignant MCA (MMCA) infarction. This study was conducted to review the outcome of surgery and to find out factors associated with favorable outcomes at a tertiary level neurosurgery referral centre. Methods and Materials: This is a retrospective study conducted over a period of three years from 2017 to 2019. Patient charts were reviewed for variable like age, sex, timing of surgery, GCS at presentation, length of ventilation, length of ICU admission and length of hospital stay. Primary outcome measure was GOSE: favorable (<=4) and unfavorable (>=5). SPSS version 23 was used for analysis. Results: A total of 28 patients underwent DHC out of which 21 patients were available for analysis. Mean age of patients was 58.62 years. Mean GCS on arrival was 11.86. Mean interval duration between event and surgery was 51.88 hours. Mean duration of ventilation was 4.43 days. Mean length of ICU stay was 5.95 days. Mean hospital stay was 22.33 days. Mean GOSE was 2. Mean age was significantly lower in patients with favorable GOSE. Early surgery had better mean GOSE which was not significant statistically. Conclusion: Patients with age less than 50 years have favorable GOSE despite MMCA infarction if decompressive hemicraniectomy is performed to accommodate brain swelling. Early surgery at presentation rather than waiting for deterioration might improve the outcome.
Dissertations / Theses on the topic "Decompressive hemicraniectomy (DHC)"
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Rahmig, Jan, Matthias Kuhn, Hermann Neugebauer, Eric Jüttler, Heinz Reichmann, and Hauke Schneider. "Normothermia after decompressive surgery for space-occupying middle cerebral artery infarction: a protocol-based approach." BioMed Central, 2017. https://tud.qucosa.de/id/qucosa%3A29678.
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Background
Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment.
Methods
We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression.
Results
We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12).
Conclusions
Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed.
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Rahmig, Jan, Matthias Kuhn, Hermann Neugebauer, Eric Jüttler, Heinz Reichmann, and Hauke Schneider. "Normothermia after decompressive surgery for space-occupying middle cerebral artery infarction: a protocol-based approach." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-231552.
Full textAbstract:
Background
Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment.
Methods
We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression.
Results
We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12).
Conclusions
Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed.