Introduction: Spontaneous intracerebral hemorrhage is one of the most devastating forms of cerebrovascular disease. Decompressive craniectomy provide space for the edematous brain to expand away from the midline structures, prevent herniation and reduce intracranial pressure.

Methods: We retrospectively reviewed the medical records of the patients with spontaneous deep supratentorial intracerebral hemorrhage who underwent decompressive craniectomy without evacuation of hematoma within 48 hours of ictus from January 2015 to January 2017. Outcome was assessed by the Glasgow Outcome Scale (GOS)3 months after surgery. The outcome was considered favorable when the patient has good recovery or moderate disability. All other categories of GOS were considered as unfavorable outcome.

Results: A total of 12 patients were included in this study. The mean age was 45 years (range 36-70 years). 75% (N=9) Of patients were younger than 50 years. Mean preoperative Glasgow Coma Scale (GCS) score was 6.7 (range 5-9). Intraventricular hemorrhage was present in 4 patients. Mean hematoma volume was 68 ml (rang 38-104ml). External ventricular drain was inserted in 3 patients. At 3 months after surgery, 8(67%) patients had favorable outcome while 4(33%) had unfavorable outcome. Mortality rate at 3 months was 17% (N=2). 50%(N=3) Of patients with GCS score 5-7 had favorable outcome and 50%(N=3) had unfavorable outcome. 83%(N=5) Of patients with GCS score 8-9 had favorable outcome while 17%(N=1) had unfavorable outcome. 71% (N=5) Of patients with hematoma volume less than or equal to 70ml had favorable outcome while 29% (N=2) had unfavorable outcome. 60% (N=3) Of patients with hematoma volume more than 70ml had favorable outcome.

Conclusions: Decompressive craniectomy can be beneficial in treatment of spontaneous deep supratentorial hemorrhage in a selected group of patients.Low preoperative GCS score is associated with poor outcome. Hematoma volume less than or equal to 70ml is associated with better outcome.

Patient Care: Decompressive craniectomy can be beneficial in treatment of spontaneous deep supratentorial hemorrhage.

Learning Objectives: Investigate the role of Decompressive craniectomy in treatment of spontaneous supratentorial intracerebral hemorrhage.

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