Effect of Decompressive Craniectomy on Perihematomal Edema in Patients with Intracerebral Hemorrhage

Perihematomal edema contributes to secondary brain injury in the course of intracerebral hemorrhage. The effect of decompressive surgery on perihematomal edema after intracerebral hemorrhage is unknown. This study analyzed the course of PHE in patients who were or were not treated with decompressive...

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Bibliographic Details
Published in:PloS one 2016-02, Vol.11 (2), p.e0149169-e0149169
Main Authors: Fung, Christian, Murek, Michael, Klinger-Gratz, Pascal P, Fiechter, Michael, Z'Graggen, Werner J, Gautschi, Oliver P, El-Koussy, Marwan, Gralla, Jan, Schaller, Karl, Zbinden, Martin, Arnold, Marcel, Fischer, Urs, Mattle, Heinrich P, Raabe, Andreas, Beck, Jürgen
Format: Article
Language:English
Subjects:
Adult
Aged
Biology and Life Sciences
Blood pressure
Brain
Brain - pathology
Brain - surgery
Brain Edema - complications
Brain Edema - pathology
Brain Edema - surgery
Brain injury
Brain research
Care and treatment
Cerebral Hemorrhage - complications
Cerebral Hemorrhage - pathology
Cerebral Hemorrhage - surgery
Complications and side effects
Computation
Computed tomography
Decompressive Craniectomy - adverse effects
Development and progression
Edema
Female
Head injuries
Hematoma
Hematoma - complications
Hematoma - pathology
Hematoma - surgery
Hemorrhage
Hospitals
Humans
Intracerebral hemorrhage
Male
Medical imaging
Medicine and Health Sciences
Middle Aged
Mortality
Neurology
Neurosurgery
Patients
People and Places
Research and Analysis Methods
Retrospective Studies
Skull
Stroke
Studies
Surgery
Tomography, X-Ray Computed
Traumatic brain injury
Treatment Outcome
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Summary:Perihematomal edema contributes to secondary brain injury in the course of intracerebral hemorrhage. The effect of decompressive surgery on perihematomal edema after intracerebral hemorrhage is unknown. This study analyzed the course of PHE in patients who were or were not treated with decompressive craniectomy. More than 100 computed tomography images from our published cohort of 25 patients were evaluated retrospectively at two university hospitals in Switzerland. Computed tomography scans covered the time from admission until day 100. Eleven patients were treated by decompressive craniectomy and 14 were treated conservatively. Absolute edema and hematoma volumes were assessed using 3-dimensional volumetric measurements. Relative edema volumes were calculated based on maximal hematoma volume. Absolute perihematomal edema increased from 42.9 ml to 125.6 ml (192.8%) after 21 days in the decompressive craniectomy group, versus 50.4 ml to 67.2 ml (33.3%) in the control group (Δ at day 21 = 58.4 ml, p = 0.031). Peak edema developed on days 25 and 35 in patients with decompressive craniectomy and controls respectively, and it took about 60 days for the edema to decline to baseline in both groups. Eight patients (73%) in the decompressive craniectomy group and 6 patients (43%) in the control group had a good outcome (modified Rankin Scale score 0 to 4) at 6 months (P = 0.23). Decompressive craniectomy is associated with a significant increase in perihematomal edema compared to patients who have been treated conservatively. Perihematomal edema itself lasts about 60 days if it is not treated, but decompressive craniectomy ameliorates the mass effect exerted by the intracerebral hemorrhage plus the perihematomal edema, as reflected by the reduced midline shift.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0149169