Decompresive hemicraniectomy
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Transcript of Decompresive hemicraniectomy
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Journal reading
Decompresive hemicraniectomy for
spontaneous intracerebral
hemorrhage
Satoru Takeuchi,MD.KojiroWada,MD.Kimihiro Nagatani,MD.
Naoki Otani,MD. and Kentaro
Mori,MD
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Introduction
intracerebral hemorrhage is devastating
decompresive hemicraniectomy is common
and usefull on this procedure
in this review, the present knowledge of the
safety and efficacy of this procedure are
evaluated
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introduction
DHC is surgical procedure to relieve malignant
elevation of ICP.
DHC procedure also has beneficial effect in
reducing ICP and can contribute to
improvement in cerebral compliance, cerebral
oxygen supply, and cerebral blood perfusion.
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Method
A PubMed search for studies was performed
favorable outcome was defined for purpose of
this review as mRS score of 0-2 or GOS
categories good recovery or moderate
disability
poor outcome w defined as mRS score 3-6 or
the GOS category severe disability, vegetative
state, or dead.
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Results
A total 9 studies were identified, reporting 226
cases in wich DHC was performed for
spontaneous hemispheric ICH.
7 study (191 cases) were treated with DHC
with hematome evacuation
2 study (35 cases) were treated with DHC
without hematome evacuation
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DHC with hematoma evacuation
Mean or median patients ages 40-60 years
Preoperative GCS : (>8 or
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DHC with hematoma evacuation
Hematoma volume :
mean and median hematome volume in 4 studies
are relatively large (>60 ml)
time onset to surgery :
7 studies are reported interval time from 3 to 22
hours
4 studies reported 67% from 124 patientsunderwent surgery within 24 hours after onset
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DHC without hematoma evacuation
23 patients : (Ramnarayan et al., 2009) Age range 31-68 years
DHC in putamen hemorrhage
GCS score was 8 or less
Hematome volume was 30-60ml
Underwent DHC 6 hours after onset Outcome was favorable in 13 patients
12 patients : (Fung et al., 2012) Median age 48 years
DHC in basal ganglia or lobar region
Median GCS score is 8 Median hematoma volume 61ml
Underwent DHC 12 hours after onset
Outcome was favorable in 4 patients
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Dicussion (DHC with hematoma evac)
Overall, we found that DHC was performed
mainly in patients with GCS score of 8 or less
an large hematomas (>60ml)
Complication such as hydrocephalus was most
frequent (19% patients with DHC)
DHC with hematoma evac have a favorable
outcome in 41% cases, and overall mortality
rate was 28%
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Dicussion (DHC with hematoma evac)
In this review 53% of patients who underwent
DHC with hematoma evac had associated with
IVH, so this procedure mught have benefit
even for patients with associated IVH.
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Discussion (DHC without hematoma
evac)
Ramnarayan et al. only 30% of patients had
GCS score 8 or less and hematoma volume
relatively small, the result was favorable
outcomes (65%) and low mortality rate (13%)
Fung et al. hemorrhage or infection
complication occurred in 17% and have
favorable outcomes and mortality rate is 25%
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Conclusion
DHC with hematoma evacuation might be safe
and effective for the treatment of large ICH
The application of only DHC without
hematoma evac for ICH is remains
inconclusive because the small number
reported patients.
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Thank You