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  • Concomitant Decompressive Craniectomy and Aneurysmal Treatment in MCA Aneurysmal Rupture Associated with Large Intracerebral Hematomas

    Final Number:
    326

    Authors:
    Mohamed Labib MD; Kevin Kwan MD; David J. Langer MD; Amir R. Dehdashti MD; Avi Setton MD; David J. Chalif MD

    Study Design:
    Other

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting

    Introduction: Literature is inconclusive regarding utility of decompressive craniectomy combined with hematoma evacuation and MCA aneurysmal occlusion as an efficacious treatment modality.

    Methods: Between 2005-2015, 14 patients with SAH/ICH from ruptured MCA aneurysms received either surgical or endovascular treatment and concomitant fronto-temporal-parietal decompressive craniectomy with delayed cranioplasty. Demographic, clinical, outcome, and radiological data of these patients were reviewed retrospectively.

    Results: Mean age was 61.6 years. Median HH and WFNS grades were 3 and 3. Seven patients required external ventricular drains. 75% of the hematomas were right sided. Median Modified Fischer Grade was 3. Hematomas were temporal in 70%. Mean hematoma volume was 17.3 ml. Mean size of MCA aneurysms was 8.07 mm. Mean hematoma volumetric evacuation rate was 55.6 %. Concomitant decompressive craniectomy and delayed cranioplasty were performed in 100% of the cohort. 92.3 % of aneurysms were clipped; 7.7 % were coiled. Mean time to cranioplasty was 37 days. 42% required shunting. At a mean follow-up of 30 months, 69.2 % of patients had a mRS of = 2.

    Conclusions: Decompressive craniectomy can be performed safely for a subcategory of MCA aneurysms that present with para-Sylvian hematomas. Our data supports the hypothesis that adjunctive decompressive craniectomy may be associated with good or excellent outcomes in a carefully selected subset of patients with MCA aneurysmal SAH treated with either endovascular or microsurgical modalities.

    Patient Care: This research will help determine whether adjunctive decompressive craniectomy may be associated with good or excellent outcomes in a carefully selected subset of patients with MCA aneurysmal SAH treated with either endovascular or microsurgical modalities

    Learning Objectives: By the conclusion of this session, participants should be able to understand the treatment paradigm and outcomes for patients presenting with SAH from MCA aneurysms with associated para-Sylvian hematoma who undergo decompressive craniectomy.

    References:

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