# Decompressive Hemicraniectomy without Evacuation of Acute Intraparenchymal Hemorrhage

## TL;DR

This study found that decompressive hemicraniectomy without removing brain hemorrhages may lead to better recovery outcomes for patients compared to clot evacuation.

## Contribution

The study introduces a novel approach of using decompressive surgery without clot removal for acute brain hemorrhages.

## Key findings

- Patients treated with DC without clot evacuation had significantly better functional outcomes.
- Younger patients (<55 years) had better functional prognosis with DC without clot evacuation.
- The type of intervention was the strongest predictor of functional recovery.

## Abstract

Background: Intracerebral hemorrhages (ICHs) are prevalent, with high morbidity and mortality. We analyzed whether decompressive craniectomy (DC) without evacuation of the acute intraparenchymal hematoma could produce better functional outcomes than treatment with evacuation. Methods: Patients with acute ICH treated with DC without clot evacuation, or evacuation with or without associated craniectomy were included. Matched univariate analyses were performed, and a binary logistic regression model was constructed using the Glasgow Outcome Scale (GOS) and modified Rankin scale (mRS) as dependent variables. Results: 27 patients treated with DC without clot evacuation were compared to 36 patients with clot evacuation; eleven of the first group were matched with 18 patients with evacuation. A significantly better functional prognosis in the group treated with DC without clot evacuation was found. Patients aged < 55 years and treated with DC without clot evacuation had a significantly better functional prognosis (p = 0.008 and p = 0.039, respectively). In multivariate analysis, the intervention performed was the greatest predictor of functional status at the end of follow-up. Conclusions: DC without clot evacuation improves the functional prognosis of patients with acute intraparenchymal hematomas. Larger multicenter studies are warranted to determine whether a change in the management of acute ICH should be recommended.