Decompressive craniectomy can improve the recovery of neurological function, daily living ability and life quality of patients with intracerebral hemorrhage after surgery

Abstract

Objective: To determine the effect of decompressive craniectomy (DC) on the recovery of neurological function, daily living ability and life quality of patients with intracerebral hemorrhage (ICH) after surgery.

Methods: Totally 290 patients with ICH admitted to our hospital from January 2018 to June 2020 were retrospectively enrolled and assigned to two groups according to different surgical methods. Among them, 138 patients who received craniotomy evacuation of hematoma (CEH) only were assigned to a control group (Con group), while the other 152 who received CEH combined with DC to a research group (Res group). The two groups were compared in the total effective rate, hematoma clearance rate, and complication rate. Additionally, the ICP and MMP-9 levels after surgery, National Institutes of Health Stroke Scale (NIHSS), activities of daily living (ADL), Fugl-Meyer Assessment of motor function (FMA), Glasgow outcome scale (GOS), Glasgow coma scale (GCS), and MOS 36-Item Short-Form Health Survey (SF-36) scores before and after surgery were also compared between the two groups.

Results: After treatment, the Res group showed a notably higher total effective rate, hematoma clearance rate, and a notably lower complication rate than the Con group. On postoperative day 3 and 7, the Res group showed notably lower ICP than the Con group, and on postoperative day 7, the Res group showed a notably lower MMP-9 level as compared with the Con group. Additionally, 6 months after the surgery, the Res group got notably lower NIHSS scores and higher ADL, GOS, and SF-36 scores as compared with the Con group, and at 1 month after surgery, the Res group got notably higher FMA scores as compared to the Con group. Moreover, on postoperative day 7, the Res group got notably higher GCS scores than the Con group.

Conclusion: DC can improve the recovery of neurological function, daily living ability and life quality of patients with ICH after surgery.

Keywords: Decompressive craniectomy; daily living ability; intracerebral hemorrhage; life quality; recovery of neurological function.

Figure 1

Comparison of ICP after surgery. The research group showed notably lower ICP than the control group at 3 and 7 days after surgery. Note: ***P < 0.001.

Figure 2

Comparison of MMP-9 level. One month after surgery, the MMP-9 level in both groups decreased greatly, and the MMP-9 level in the research group was notably lower than that in the control group. Note: ***P < 0.001.

Figure 3

Comparison of NIHSS and ADL scores. A. Six months after surgery, the NIHSS score of both groups decreased greatly, and the NIHSS score of the research group was notably lower than that of the control group. B. Six months after surgery, the ADL score of both groups increased significantly, and the ADL score of the Res group was significantly higher than that of the control group. Note: ***P < 0.001.

Figure 4

Comparison of FMA score. One month after surgery, the FMA scores of both groups increased greatly, and the FMA score of the research group was notably higher than that of the control group. Note: ***P < 0.001.

Figure 5

Comparison of GCS and GOS scores. A. Seven days after surgery, the GCS scores of both groups increased greatly, and the GCS score of the research group was notably higher than that of the control group. B. Six months after surgery, the GOS score of the research group was significantly higher than that of the control group. Note: ***P < 0.001.

Figure 6

Comparison of SF-36 score. Six months after surgery, the general health (A), physiological functioning (B), role physical (C), bodily pain (D), vitality (E), social function (F), role emotional (G) and mental health (H) scores of the research group were significantly higher than those of the control group. Note: ***P < 0.001.