Introduction: The optimum management for patients with spontaneous intracerebral hemorrhage (ICH) has not been well established. Decompressive craniectomy (DC) is a surgical procedure to relieve malignant elevation of intracranial pressure, which has been shown to be effective for patients with traumatic brain injury or malignant middle cerebral artery infarction. Some studies suggest that DC following surgical clot evacuation help relieve intracranial pressure and benefit the patients suffered ICH, especially with big hematoma. However some studies indicate that DC may not be essential after the hematoma is surgically evacuated, which induces long hospital stay and a second surgery for cranioplasty.
Hypothesis: To compare the effect of clot evacuation with DC or without DC (non-DC) on the outcome of patients with spontaneous supratentorial intracerebral hemorrhage (ICH).
Methods: 89 consecutive spontaneous supratentorial ICH patients were randomized into DC or non-DC groups. We compared hematoma volume, operative duration, operation bleeding volume, the intracranial pressure fluctuation, mRS after 3 months, and postoperative complications. Statistical analysis was done using the t-test or Chi-square test, and the odds ratio was calculated.
Results: Mean hematoma volume was 51.4±17.5 mL in DC group and 49. 8±14.6 mL in non-DC group. Clot clearance rate was 94.2±4.6% in DC group and 92.6±3.9% in non-DC group. Mean operation duration and bleeding volume in DC group were more than that in Non-DC group. After 3 months, the outcome of DC group was worse than that in non-DC group. Finally, intracranial pressure monitoring showed that intracranial pressure within five days after surgery fluctuated within 8.9∼16.1 mmHg in DC group and within 9.5∼18.9 mmHg in non-DC group (no significant difference).
Conclusions: It is not necessary to do decompressive craniectomy in patients with supratentorial ICH when surgically performing hematoma evacuation.