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. 2012 Sep;3(3):251-5.
doi: 10.4103/0976-3147.102598.

Decompressive craniectomy in patients with cerebral infarction due to malignant vasospasm after aneurysmal subarachnoid hemorrhage

Saffet Tuzgen  1 , Baris Kucukyuruk, Seckin Aydin, Fatma Ozlen, Osman Kizilkilic, Bashar Abuzayed
Affiliations

Decompressive craniectomy in patients with cerebral infarction due to malignant vasospasm after aneurysmal subarachnoid hemorrhage

Saffet Tuzgen et al. J Neurosci Rural Pract. 2012 Sep.

Abstract

Aim: The authors present their experience and the clinical results in decompressive craniectomy (DC) in patients with vasospasm after aneurysmal subarachnoid hemorrhage (SAH).

Materials and methods: Between 2002 and 2010, six patients underwent DC due to cerebral infarct and edema secondary to vasospasm after aneurysmal SAH. Four patients were male, and two were female. The age of patients ranged between 33 and 60 (mean: 47,6 ± 11,4). The follow up period ranged between 12 to 104 months (mean: 47,6 ± 36,6). The SAH grading according World Federation of Neurosurgeons (WFNS) score ranged between 3 to 5.

Results: Last documented modified Rankin Score (mRS) ranged between 2 to 6. One patient died in the following year after decompression due to pneumonia and sepsis. Two patients had moderate disability (mRS of 4) and three patients continue their life with minimal deficit and no major dependency (mRS score 2 and 3).

Conclusion: DC can be a life-saving procedure which provides a better outcome in patients with cerebral infarction secondary to vasospasm and SAH. However, the small number of the patients in this study is the main limitation of the accuracy of the results, and more studies with larger numbers are required to evaluate the efficiency of DC in this group of patients.

Keywords: Cerebral infarction; decompressive craniectomy; subarachnoid hemorrhage; vasospasm.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
A case of SAH due to ruptured right MCA bifurcation aneurysm. Malignant vasospasm was developed in the territory of the left MCA (a) Cerebral angiography after surgical clipping of the aneurysm and developement of the vasospasm showing severe vasospasm in the left MCA (b) Cerebral angiographic views during the attempt of angioplasty of the left MCA (c) Brain CT-scan showing ischemic changes and edema in the contralateral MCA territory with midline shift. (Note: right intraventricular catheter is not visible as this CT section is immediately below the tip of the catheter which slightly upward migrated after subfalcian herniation) (d) Brain CT-scan obtained after decompressive craniectomy performed via a left fronto-parietotemporal craniectomy and removal of the intraventricular catheter
Figure 2
Figure 2
(a) A schematic drawing demonstarting the skin incision for DC in previously unoperated side (b) and in case with previous operation with pterional craniotomy
See this image and copyright information in PMC

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