Die sekundäre Dekompressionstrepanation bei zunehmendem posttraumatischem Hirnödem nach primärer Entlastungskraniotomie. Guidelines for the Management of Severe Traumatic Brain Injury: 2020 update of the decompressive craniectomy recommendations. The bigger, the better? About the size of decompressive hemicraniectomies. Superior sagittal sinus sparing craniectomy: Incidence of shear-bleeding and shunt-dependency. Decompressive hemicraniectomy for the treatment of intractable intracranial hypertension after aneurysmal subarachnoid hemorrhage. Intracranial hypertension in subarachnoid hamorrhage: Outcome after decompressive craniectomy. PrImary decompressive Craniectomy in AneurySmal Subarachnoid hemOrrhage (PICASSO) trial: Study protocol for a randomized controlled trial. Decompressive hemicraniectomy in patients with subarachnoid hemorrhage and intractable intracranial hypertension. Surgical outcome following decompressive craniectomy for poor-grade aneurysmal subarachnoid hemorrhage in patients with associated massive intracerebral or sylvian hematomas. Proposed use of prophylactic decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage patients presenting with associated large sylvian hematomas. The PRESSURE score to predict decompressive craniectomy after aneurysmal subarachnoid hemorrhage. Decompressive craniectomy in subarachnoid hemorrhage. The authors declare no conflict of interest. Thus, the severity of the underlying SAH seems to be the main factor for long-term functional outcome. The lack of statistical significance in our outcomes might be attributed to generally large size of the DC in our cohort, where both groups exceeded the 105 cm 2 proposed by Jabbarli et al. , our data showed no difference in long term outcome between the groups but showed a trend of lower mortality rates in patients with larger DC size. Similar to the results of Jabbarli et al. Our findings support the benefit of the larger bone flap in poor-grade SAH patients undergoing DC. These authors emphasize that larger DC size positively impacts both approach-related surgical complications and long term outcome in patients with traumatic brain injury, spontaneous intracerebral hemorrhage, and cerebral infarction. In the contemporary literature, some authors already postulate craniectomies overreaching the 180 cm 2 proposed by the TBI guideline. The recommendation given on the size of the DC so far is the minimum of 12 × 15 cm large bone flap recommended by the TBI guideline, which also strongly emphasizes the sufficient temporobasal decompression. To date, there is still no agreement about the exact size and margin of the DC. In poor-grade aneurysmal SAH, the initial planning of DC-if deemed necessary -and enlargement of the flap size seems to decrease the rate of postoperatively developed shear bleeding lesions. We found no difference regarding modified Rankin Scale (mRS) 6 months postoperatively. 23/53, p = 0.07) or number of implanted VP shunts (2/14 vs. However, we found no difference in mortality rates (10/14 vs. In patients with shear bleeding, the size of the bone flap was significantly smaller compared to patients without shear bleeding (102.1 ± 45.2 cm 2 vs. We found 14 patients with new shear bleeding lesion in postoperative CT scan. Between 01/2012 and 01/2020, 67 poor-grade SAH patients underwent clipping and craniectomy at our institution. The size of the bone flap was calculated using the De Bonis equation. Postoperative CT scans were analyzed for approach-related tissue injury at the margin of the craniectomy (shear bleeding). We retrospectively analyzed poor-grade SAH patients (WFNS 4 and 5) who underwent aneurysm clipping and craniectomy (DC or ommitance of bone flap reinsertion). The aim of the present study was to analyze the size of the bone flap according to approach-related complications in patients with poor-grade SAH. Decompressive craniectomy is an option to decrease elevated intracranial pressure in poor-grade aneurysmal subarachnoid hemorrhage (SAH) patients.
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