Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 years

TL;DR

This study compares the effectiveness of decompressive craniectomy in treating subarachnoid hemorrhage versus traumatic brain injury and stroke.

Contribution

The study provides an institutional analysis of decompressive craniectomy outcomes across different brain injury types over 11 years.

Findings

Favorable outcomes were more common in traumatic brain injury compared to stroke in univariate analysis.

Subarachnoid hemorrhage showed no significant difference in favorable outcomes compared to ischemic stroke.

Mortality rates were highest in subarachnoid hemorrhage patients who underwent decompressive craniectomy.

Abstract

Decompressive craniectomy (DC) is a last-tier procedure to lower intracranial pressure in otherwise fatal brain injuries. DC significantly reduces mortality following traumatic brain injury (TBI) and ischemic stroke, but benefits in subarachnoid hemorrhage (SAH) are less clear.

We compared the mortality and functional outcomes in patients who underwent DC after SAH with those who underwent DC following TBI or ischemic stroke.

All DC procedures performed in the Oulu University Hospital between January 2009 and December 2019 were retrospectively identified. Mortality and functional outcomes were assessed during a median follow-up of 20.7 months. Extended Glasgow Outcome Scale scores ≥5 were considered favorable.

One hundred twenty-four DCs were conducted to patients aged a median of 40 years (SD 16), of whom 88 (71%) were male. Fifty-eight (47%) DCs were due to TBI and 66 (53%) due to stroke. Of the strokes, 41 (62%) were ischemic and 21 (32%) SAH.

In multivariate models, the rates of unfavorable outcome were 48% in TBI, 78% in ischemic stroke (OR 2.73, 95% CI 0.70–10.64) and 86% in SAH (OR 3.15, 95%CI 0.67–14.77). Mortality rates were 22% in TBI, 17% in ischemic stroke (OR 0.50, 95%CI 0.11–2.31) and 33% in SAH (OR 0.97, 95%CI 0.24–3.99).

Favorable outcomes were more common in TBI compared to stroke in univariate but not in multivariate analysis. There was no statistically significant difference in the rates of favorable outcomes between SAH and ischemic stroke.

•Seven of the 21 (33%) patients with SAH who underwent DC died, and 3/21 (14%) achieved a favorable outcome.•There was no statistically significant difference in favorable outcome between SAH and ischemic stroke.•Favorable functional outcome was more common in TBI compared to stroke in univariate but not in multivariate analysis.

Seven of the 21 (33%) patients with SAH who underwent DC died, and 3/21 (14%) achieved a favorable outcome.

There was no statistically significant difference in favorable outcome between SAH and ischemic stroke.

Favorable functional outcome was more common in TBI compared to stroke in univariate but not in multivariate analysis.

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