Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Sep 7;46(1):231.
doi: 10.1007/s10143-023-02138-6.

Thiopental and decompressive craniectomy as last-tier ICP-treatments in aneurysmal subarachnoid hemorrhage: is functional recovery within reach?

Sofie Björk  1 , Anders Hånell  1 , Elisabeth Ronne-Engström  1 , Anton Stenwall  1 , Fartein Velle  1 , Anders Lewén  1 , Per Enblad  1 , Teodor Svedung Wettervik  2
Affiliations
Observational Study

Thiopental and decompressive craniectomy as last-tier ICP-treatments in aneurysmal subarachnoid hemorrhage: is functional recovery within reach?

Sofie Björk et al. Neurosurg Rev. .

Abstract

The study aimed to investigate the indication and functional outcome after barbiturates and decompressive craniectomy (DC) as last-tier treatments for elevated intracranial pressure (ICP) in aneurysmal subarachnoid hemorrhage (aSAH). This observational study included 891 aSAH patients treated at a single center between 2008 and 2018. Data on demography, admission status, radiology, ICP, clinical course, and outcome 1-year post-ictus were collected. Patients treated with thiopental (barbiturate) and DC were the main target group.Thirty-nine patients (4%) were treated with thiopental alone and 52 (6%) with DC. These patients were younger and had a worse neurological status than those who did not require these treatments. Before thiopental, the median midline shift was 0 mm, whereas basal cisterns were compressed/obliterated in 66%. The median percentage of monitoring time with ICP > 20 mmHg immediately before treatment was 38%, which did not improve after 6 h of infusion. Before DC, the median midline shift was 10 mm, and the median percentage of monitoring time with ICP > 20 mmHg before DC was 56%, which both significantly improved postoperatively. At follow-up, 52% of the patients not given thiopental or operated with DC reached favorable outcome, whereas this occurred in 10% of the thiopental and DC patients.In summary, 10% of the aSAH cohort required thiopental, DC, or both. Thiopental and DC are important integrated last-tier treatment options, but careful patient selection is needed due to the risk of saving many patients into a state of suffering.

Keywords: Aneurysmal subarachnoid hemorrhage; Decompressive craniectomy; Intracranial pressure; Outcome; Thiopental.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
DIND diagnosis and treatment. The figure illustrates the diagnosis and treatment of DIND. BP, blood pressure; EVF, erythrocyte volume fraction
Fig. 2
Fig. 2
Escalated ICP-treatments. The figure illustrates the escalation of treatments to keep ICP below 20 mmHg. The specific steps are described in detail in the text
Fig. 3
Fig. 3
Clinical outcome at 1-year follow-up post-ictus
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ahmed SI, Javed G, Bareeqa SB, Samar SS, Shah A, Giani A, Aziz Z, Tasleem A, Humayun SH. Endovascular coiling versus neurosurgical clipping for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Cureus. 2019;11:e4320. doi: 10.7759/cureus.4320. - DOI - PMC - PubMed
    1. Alotaibi NM, Elkarim GA, Samuel N, Ayling OGS, Guha D, Fallah A, Aldakkan A, Jaja BNR, de Oliveira Manoel AL, Ibrahim GM, Macdonald RL. Effects of decompressive craniectomy on functional outcomes and death in poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2017;127:1315–1325. doi: 10.3171/2016.9.Jns161383. - DOI - PubMed
    1. Alotaibi NM, Wang JZ, Pasarikovski CR, Guha D, Al-Mufti F, Mamdani M, Saposnik G, Schweizer TA, Macdonald RL. Management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage: time for a consensus? Neurosurg Focus. 2017;43:E13. doi: 10.3171/2017.7.Focus17426. - DOI - PubMed
    1. Brandecker S, Hadjiathanasiou A, Kern T, Schuss P, Vatter H, Güresir E. Primary decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage: long-term outcome in a single-center study and systematic review of literature. Neurosurg Rev. 2021;44:2153–2162. doi: 10.1007/s10143-020-01383-3. - DOI - PMC - PubMed
    1. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the management of severe traumatic brain injury, Fourth Edition. Neurosurgery. 2017;80:6–15. doi: 10.1227/neu.0000000000001432. - DOI - PubMed

Publication types

LinkOut - more resources