Effect of decompressive craniectomy alone without hematoma evacuation on perihematomal edema and prognosis in elderly patients with spontaneous intracerebral hemorrhage
ZHANG Xi-bing
LI Dong-hua
ZHANG Ming
LI Hai-long
Abstract：Objective To investigate the effects of decompressive craniectomy(DC)alone without hematoma evacuation on perihematomal edema(PHE)and prognosis in elderly patients with spontaneous intracerebral hemorrhage(ICH).Methods THe clinical data of 25 elderly patients with acute spontaneous ICH who underwent DC(without hematoma evacuation)between May 2021 and December 2023 were retrospectively analyzed.A control group of 25 age-and imaging-matched elderly spontaneous ICH patients receiving conservative treatment was selected in a 1:1 ratio.PHE volume was measured using 3D Slicer 4.6.2 software based on the data of CT scans.Outcomes were assessed at 6 months post-treatment using the modified Rankin Scale(mRS),with scores of 0～2 indicating good outcomes.Results PHE volume in both groups initially increased and then decreased.The control group reached peak PHE volume at 21 days post-hemorrhage,while the DC group peaked at 14 days.Compared to the control group,the DC group showed significantly higher absolute and relative PHE volumes at 14 and 21 days post-hemorrhage(P<0.05).At 30 days post-hemorrhage,midline shift in the DC group decreased significantly from baseline(P<0.05)and was markedly lower than in the control group(P<0.05).At 6-month follow-up,the good outcome rate was significantly higher in the DC group(72.0%)than in the control group(40.0%;P<0.05).No significant differences were observed in mortality or complication rates(P>0.05).Conclusion Compared with conservative treatment,DC without hematoma evacuation is associated with increased early PHE volume in elderly patients with acute spontaneous ICH.However,even without hematoma removal,DC alone helps alleviate mass effect,reduce midline shift,and improve neurological outcomes.
Keywords：Spontaneous intracerebral hemorrhageDecompressive craniectomyElderly patientsPerihematomal edemaPrognosis
Publication Date：2025-04-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 205-208 )