Taco Goedemans1, Dagmar Verbaan1, Bert A Coert1, Bertjan J Kerklaan2, René van den Berg3, Jonathan M Coutinho4, Tessa van Middelaar4, Paul J Nederkoorn4, William Peter Vandertop1, Pepijn van den Munckhof5. 1. Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. 2. Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, and Zaans Medical Center, Zaandam, The Netherlands. 3. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands. 5. Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: p.vandenmunckhof@amc.nl.
Abstract
OBJECTIVE: Decompressive craniectomy (DC) has been proposed as a lifesaving treatment in patients with elevated intracranial pressure, but its effectiveness on reaching a favorable neurologic outcome remains unclear. We identified predictors of outcome in a large, single-center cohort of patients undergoing DC for different pathologic conditions. METHODS: This retrospective study included all patients undergoing DC from 2006 to 2014. The 1-year outcome, assessed using the Glasgow Outcome Scale (GOS), was dichotomized into favorable (GOS 4-5) and unfavorable (GOS 1-3) outcome. Predictors of outcome were identified by analyzing patient characteristics. RESULTS: DC was performed in 204 patients for ischemic stroke (n = 57), traumatic brain injury (n = 50), aneurysmal subarachnoid hemorrhage (aSAH) (n = 44), intracerebral hemorrhage (ICH) (n = 29), cerebral venous thrombosis (CVT) (n = 14), or other indications (n = 10). Overall, 69 (34%) patients survived favorably, 39 (19%) survived unfavorably, and 96 (47%) died. Higher age, poor Glasgow Coma Scale score, intubated status before DC, bilateral absence of pupillary light reflexes, DC for aSAH, and additional surgeries after DC (excluding cranioplasty) were significant predictors of unfavorable outcome. When patients were sorted for pathologic conditions and predictors of outcome, favorable outcome rates differed remarkably, ranging from 91% for CVT patients undergoing uncomplicated DC to 0% for aSAH patients undergoing DC for secondary infarction or ICH patients with unilateral or bilateral abnormal pupillary light reflexes upon admission. CONCLUSIONS: Long-term neurologic outcome after DC differed remarkably among subpopulations of patients, with favorable outcome rates ranging from 0% to >90%.
OBJECTIVE: Decompressive craniectomy (DC) has been proposed as a lifesaving treatment in patients with elevated intracranial pressure, but its effectiveness on reaching a favorable neurologic outcome remains unclear. We identified predictors of outcome in a large, single-center cohort of patients undergoing DC for different pathologic conditions. METHODS: This retrospective study included all patients undergoing DC from 2006 to 2014. The 1-year outcome, assessed using the Glasgow Outcome Scale (GOS), was dichotomized into favorable (GOS 4-5) and unfavorable (GOS 1-3) outcome. Predictors of outcome were identified by analyzing patient characteristics. RESULTS: DC was performed in 204 patients for ischemic stroke (n = 57), traumatic brain injury (n = 50), aneurysmal subarachnoid hemorrhage (aSAH) (n = 44), intracerebral hemorrhage (ICH) (n = 29), cerebral venous thrombosis (CVT) (n = 14), or other indications (n = 10). Overall, 69 (34%) patients survived favorably, 39 (19%) survived unfavorably, and 96 (47%) died. Higher age, poor Glasgow Coma Scale score, intubated status before DC, bilateral absence of pupillary light reflexes, DC for aSAH, and additional surgeries after DC (excluding cranioplasty) were significant predictors of unfavorable outcome. When patients were sorted for pathologic conditions and predictors of outcome, favorable outcome rates differed remarkably, ranging from 91% for CVTpatients undergoing uncomplicated DC to 0% for aSAH patients undergoing DC for secondary infarction or ICHpatients with unilateral or bilateral abnormal pupillary light reflexes upon admission. CONCLUSIONS: Long-term neurologic outcome after DC differed remarkably among subpopulations of patients, with favorable outcome rates ranging from 0% to >90%.
Authors: Taco Goedemans; Dagmar Verbaan; Olivier van der Veer; Maarten Bot; René Post; Jantien Hoogmoed; Michiel B Lequin; Dennis R Buis; W Peter Vandertop; Bert A Coert; Pepijn van den Munckhof Journal: J Neurol Date: 2020-01-17 Impact factor: 4.849