Abstract

Research Article

Factors associated with mortality after decompressive craniectomy in large basal ganglia bleeds

Amit Kumar Thotakura*, Nageswara Rao Marabathina, Rama Krishnareddy Mareddy and Sivaramanjaneyulu Yeddanapudi

Published: 11 May, 2021 | Volume 5 - Issue 1 | Pages: 029-033

Aim: To assess the efficacy of decompressive craniectomy in patients with large basal ganglia (BG) bleed. To establish predictive criteria of mortality after surgery in patients with BG bleed.

Materials: This prospective study includes all patients of large spontaneous BG bleed operated by decompressive craniectomy without hematoma evacuation from October 2012 to September 2015. Data was collected on patient age, gender, distribution of bleed, affected hemisphere dominancy, preexisting medical conditions, admission Glasgow Coma Score (GCS), midline shift on CT or MRI Brain, hematoma volume and anisocoria, duration (hours) between the onset of stroke and operation, post-operative complications, and the duration of hospital stay. This data was correlated with one month mortality of the patients.

Results: Total number of patients were 27. Mean age was 51 years and mean GCS was 7.55(range 5-11). The mean volume of the bleed was 68.51 ml. Mortality was noted in 17 out of 27 patients (63%) in 30 days. Thirteen of the 16 patients with intraventricular extension of BG bleed had mortality. The factors that showed statistically significant correlation with one month mortality were age, GCS at admission, volume of the bleed and the intraventricular extension.

Conclusion: Large BG bleed was associated with high mortality and morbidity. Age of 50 years or more and GCS ≤ 8 at presentation were poor prognostic factors for decompressive craniectomy in patients with BG bleed. Patients with large BG bleed of volume > 60 ml and intraventricular extension had poor prognosis.

Read Full Article HTML DOI: 10.29328/journal.jnnd.1001048 Cite this Article Read Full Article PDF

Keywords:

Large ICH; Outcome; Decompressive craniectomy; Surgery for ICH; Capsuloganglionic bleed; Basal ganglia bleed

References

  1. Takeuchi S, Wada K, Nagatani K, Otani N, Mori K. Decompressive hemicraniectomy for spontaneous intracerebral hemorrhage. Neurosurg Focus. 2013; 34: E5. PubMed: https://pubmed.ncbi.nlm.nih.gov/23634924/
  2. Ramnarayan R, Anto D, Anilkumar TV, Nayar R. Decompressive hemicraniectomy in large putaminal hematomas: an Indian experience. J Stroke Cerebrovasc Dis. 2009; 18: 1-10. PubMed: https://pubmed.ncbi.nlm.nih.gov/19110137/
  3. Fung C, Murek M, Z'Graggen WJ, Krähenbühl AK, Gautschi OP, et al. Decompressive hemicraniectomy in patients with supratentorial intracerebral hemorrhage. Stroke. 2012; 43: 3207-3211. PubMed: https://pubmed.ncbi.nlm.nih.gov/23111437/
  4. Heuts SG, Bruce SS, Zacharia BE, Hickman ZL, Kellner CP, et al. Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis Neurosurg Focus. 2013; 34: E4. PubMed: https://pubmed.ncbi.nlm.nih.gov/23634923/
  5. Esquenazi Y, Savitz SI, El Khoury R, McIntosh MA, Grotta JC, et al. Decompressive hemicraniectomy with or without clot evacuation for large spontaneous supratentorial intracerebral hemorrhages. Clin Neurol Neurosurg. 2015; 128: 117-122. PubMed: https://pubmed.ncbi.nlm.nih.gov/25496934/
  6. Helweg-Larsen S, Sommer W, Strange P, Lester J, Boysen G. Prognosis for patients treated conservatively for spontaneous intracerebral hematoma. Stroke. 1984; 15: 1045-1048. PubMed: https://pubmed.ncbi.nlm.nih.gov/6506116/
  7. Kanno T, Nagata J, Hoshino M, Nakagawa T, Asai T, et al. Evaluation of hypertensive intracerebral haematomas based on the study of long term outcome—part IV prognostic importance of the age of the patient and the laterality of the lesion in putaminal haemotoma. No shinkei geka. Neurological Surg. 1986; 14: 1539-1545. PubMed: https://pubmed.ncbi.nlm.nih.gov/3822054/
  8. Kilincer C, Asil T, Utku U, Hamamcioglu MK, Turgut N, et al. Factors affecting the outcome of Decompressive craniectomy for large hemispheric infarction: a prospective study. Acta Neurochir (Wien). 2005; 147: 587-594. PubMed: https://pubmed.ncbi.nlm.nih.gov/15739038/
  9. Li Q, Yang CH, Xu JG, Li H, You C. Surgical treatment for large spontaneous basal ganglia haemorrhage:retrospective analysis of 253 cases. Br J Neurosurg. 2013; 27: 617-621. PubMed: https://pubmed.ncbi.nlm.nih.gov/23406426/
  10. Bhatia R, Singh H, Singh S, Padma MV, Prasad K, et al. A prospective study of in-hospital mortality and discharge outcome in spontaneous intracerebral hemorrhage. Neurol India. 2013; 61: 244–248. PubMed: https://pubmed.ncbi.nlm.nih.gov/23860142/
  11. Takeuchi S, Takasato Y, Masaoka H, Hayakawa T, Yatsushige H, et al. Decompressive craniectomy with haematoma evacuation for large hemispheric hypertensive intra cerebral haemorrhage. Acta Neurochir Suppl. 2013; 118: 277-279. PubMed: https://pubmed.ncbi.nlm.nih.gov/23564148/
  12. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993; 24: 987–993. PubMed: https://pubmed.ncbi.nlm.nih.gov/8322400/
  13. Tuhrim S, Dambrosia JM, Price TR, Mohr JP, Wolf PA, et al. Prediction of intracerebral hemorrhage survival. Ann Neurol. 1988; 24: 258-263. PubMed: https://pubmed.ncbi.nlm.nih.gov/3178180/
  14. Yousuf RM, Fauzi ARM, Jamalludin AR. Predictors of in-hospital mortality in primary intracerebral haemorrhage in East coast of Peninsular Malaysia. Neurology Asia. 2012; 17: 93-99.
  15. Suthar NN, Patel KL, Saparia C, Parikh AP. Study of clinical and radiological profile and outcome in patients of intracranial hemorrhage. Ann Afr Med. 2016; 15: 69-77. PubMed: https://pubmed.ncbi.nlm.nih.gov/27044730/
  16. Nilsson OG, Lindgren A, Brandt L, Säveland H. Prediction of death in patients with primary intracerebral hemorrhage: A prospective study of a defined population. J Neurosurgery. 2002; 97: 531–536. PubMed: https://pubmed.ncbi.nlm.nih.gov/12296635/
  17. Tshikwela ML, Longo-Mbenza B. Spontaneous intracerebral hemorrhage: Clinical and computed tomography findings in predicting in-hospital mortality in Central Africans. J Neurosci Rural Pract. 2012; 3: 115–120. PubMed: https://pubmed.ncbi.nlm.nih.gov/22865958/
  18. Hemphill JC, 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: A simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001; 32: 891–897. PubMed: https://pubmed.ncbi.nlm.nih.gov/11283388/
  19. Sia SF, Tan KS, Waran V. Primary intracerebral haemorrhage in Malaysia: in-hospital mortality and outcome in patients from a hospital based registry. Med J Malaysia. 2007; 62: 308-312. PubMed: https://pubmed.ncbi.nlm.nih.gov/18551935/
  20. Cho DY, Chen CC, Lee HC, Lee WY, Lin HL. Glasgow Coma Scale and hematoma volume as criteria for treatment of putaminal and thalamic intracerebral hemorrhage. Surg Neurol. 2008; 70: 628-633. PubMed: https://pubmed.ncbi.nlm.nih.gov/18207500/
  21. Nag C, Das K, Ghosh M, Khandakar MR. Prediction of clinical outcome in acute haemorrhagic stroke from a single CT scan on admission. N Am J Med Sci. 2012; 4: 463-467. PubMed: https://pubmed.ncbi.nlm.nih.gov/23112967/
  22. Celikbilek A, Goksel BK, Zararsiz G, Benli S. Spontaneous intra-cerebral hemorrhage: A retrospective study of risk factors and outcome in a Turkish population. J Neurosci Rural Pract. 2013; 4: 271-277. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821411/
  23. Safatli DA, Günther A, Schlattmann P, Schwarz F, Kalff R, et al. Predictors of 30-day mortality in patients with spontaneous primary intracerebral hemorrhage. Surg Neurol Int. 2016; 1: 7(Suppl 18): S510-517. PubMed: https://pubmed.ncbi.nlm.nih.gov/27583176/
  24. Franke CL, van Swieten JC, Algra A, van Gijn J. Prognostic factors in patients with intracerebral haematoma. J Neurol Neurosurg Psychiatry. 1992; 55: 653-657. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC489199/
  25. Narayan SK, Sivaprasad P, Sushma S, Sahoo RK, Dutta TK. Etiology and outcome determinants of intracerebral hemorrhage in a south Indian population, A hospital-based study. Ann Indian Acad Neurol. 2012; 15: 263-266. PubMed: https://pubmed.ncbi.nlm.nih.gov/23349590/
  26. Zia E, Engstrom G, Svensson PJ, Norrving B, Pessah-Rasmussen H. Three-Year Survival and Stroke Recurrence Rates in Patients With Primary Intracerebral Hemorrhage. Stroke. 2009; 40: 3567-3573. PubMed: https://pubmed.ncbi.nlm.nih.gov/19729603/
  27. Lin CL, Howng SL. Surgical outcome of hypertensive putaminal hemorrhage in patients older than 65 years. Kaohsiung J Med Sci. 1998; 14: 280-285. PubMed: https://pubmed.ncbi.nlm.nih.gov/9619013/
  28. Hallevi H, Albright KC, Aronowski J, Barreto AD, Martin-Schild S, et al. Intraventricular haemorrhage:Anatomic relationship and clinical implications Neurology. 2008; 70: 848-852. PubMed: https://pubmed.ncbi.nlm.nih.gov/18332342/

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