• World Neurosurg · Jan 2011

    Clinical characteristics and surgical outcomes of patients with aneurysmal subarachnoid hemorrhage and acute subdural hematoma undergoing decompressive craniectomy.

    • Naoki Otani, Yoshio Takasato, Hiroyuki Masaoka, Takanori Hayakawa, Yoshikazu Yoshino, Hiroshi Yatsushige, Hiroki Miyawaki, Kyoko Sumiyoshi, Takashi Sugawara, Aoyagi Chikashi, Satoru Takeuchi, and Goh Suzuki.
    • Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
    • World Neurosurg. 2011 Jan 1;75(1):73-7.

    ObjectiveThis report presents 12 consecutively managed patients with aneurysmal subarachnoid hemorrhage (SAH) associated with acute subdural hematoma (ASDH) who underwent decompressive craniectomy (DC) with special attention to their clinical characteristics and surgical outcomes.MethodsWe retrospectively reviewed medical charts, radiologic findings, surgical notes, and video records.ResultsAmong these 12 patients (mean age 59.1 years, 4 men, 8 women), the Hunt and Kosnik clinical grade was grade V in 7 patients (58.3%), grade IV in 2 patients (16.7%), grade III in 2 patients (16.7%), and grade II in 1 patient (8.3%). The aneurysms were located on the internal carotid artery in four patients, the middle cerebral artery in six patients, and the anterior communicating artery in two patients. Computed tomography findings on admission revealed ASDH in all patients. In addition, SAH was seen in 11 patients. An intracerebral hematoma was found in eight patients, intraventricular hemorrhaging occurred in four, and an acute hydrocephalus was seen in one patient. All patients underwent a microsurgical clipping procedure and an additional DC. Symptomatic vasospasm was confirmed in six (50%), and eight patients with chronic hydrocephalus received a ventriculoperitoneal shunt (67%). The Glasgow Outcome Scale at discharge showed good recovery in five patients (41.7%), severe disability in four (33.3%), vegetative state in two (16.7%), and death in one patient (8.3%). A favorable outcome was achieved in five patients (41.7%).ConclusionsWe suggest that the DC was effective for reducing morbidity and mortality in poor grade patients with SAH presenting with ASDH.Copyright © 2011 Elsevier Inc. All rights reserved.

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