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• W2617148712 abstract "Background: To investigate the pattern of care and outcomes of patients with a ruptured intracranial aneurysm who underwent decompressive hemicraniectomy (DH), and compare the patient characteristics as well as short- and long-term outcomes. Methods: All patient data were obtained from the Swiss SOS database, at time of analysis covering 1,572 patients treated for aneurysmal subarachnoid hemorrhage (aSAH) at one of eight Swiss neurovascular centers between January 2009 and December 2013. Results: From 1,572 patients in the database, 197 patients (12.5%; 66% female, 29% 60 years or older) underwent DH and 1,375 patients did not. Candidates for DH were younger (53.0 vs. 55.0 years, p = 0.014), showed worse hospital admission scores (GCS 8.0 vs. 14.0, p < 0.0001; WFNS 4.0 vs. 2.0, p < 0.0001), and were more likely to present with a neurological deficit (OR 2.90, 95% CI 2.10–3.99, p < 0.0001), epileptic seizures (OR 2.03, 95% CI 1.22–3.37, p = 0.0107), or mydriasis (OR 2.33, 95% CI 1.32–4.10, p = 0.0052). At the initial CT, 43% of patients presented with midline shift (OR 3.88, 95% CI 2.47–6.10, p < 0.0001); 51% had an intracerebral hemorrhage (ICH; OR 4.70, 95% CI 3.16–6.99, p < 0.0001) and 36% subdural hematoma (OR 3.26, 95% CI 2.04–5.19, p < 0.0001). In addition, patients suffering from delayed cerebral ischemia were more likely to receive DH (OR 3.07, 95% CI 1.91–4.92, p < 0.0001). Patients who underwent DH were more likely to be clipped than coiled (OR 7.18, 95% CI 5.05–10.21, p < 0.0001) and profited from surgical removal of ICH in 43% of cases (OR 10.38, 95% CI 6.36–16.94, p < 0.0001). Overall hospitalization (25 vs. 18 days, p < 0.0001) and stay in the intensive care unit (17 vs 8 days, p < 0.0001) were longer for patients undergoing DH. Patients receiving DH were more likely to die in-hospital (OR 2.68, 95% CI 1.93–3.71, p < 0.0001) or be discharged in an unfavorable neurological status (mRS 4–5; OR 3.67, 95% CI 2.65–5.09, p < 0.0001). One year after aSAH, the mortality of patients with and without DH was 37 and 20% (p < 0.0001), and 16% with versus 4% without DH presented an unfavorable neurological status (mRS 4–5; OR 4.72, 95% CI 2.78–8.01, p < 0.0001). Conclusion: DH in aSAH was performed in 13% of patients, usually in those that present with worse admission scores, ICH, or acute SDH, or suffer from DCI. Despite maximal treatment, patients requiring DH will have a high mortality (37% at 1 year) and the rate of functional dependence is significant in survivors (39% at discharge, 16% at 1 year)." @default.
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• W2617148712 date "2015-09-07" @default.
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• W2617148712 title "Decompressive Hemicraniectomy in Aneurysmal Subarachnoid Hemorrhage—Insights from a Swiss National Database (Swiss SOS)" @default.
• W2617148712 doi "https://doi.org/10.1055/s-0035-1564340" @default.
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