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. 2025 Mar;71(2):101656.
doi: 10.1016/j.neuchi.2025.101656. Epub 2025 Mar 7.

The impact of primary decompressive craniectomy in ruptured middle cerebral artery aneurysms with intraparenchymal hematoma

Thomas Metayer  1 , Charles-Henry Mallereau  2 , Charles Peltier  3 , Chloe Dumot  4 , Florian Bernard  5 , Pierre-Jean Le Reste  6 , Anne-Laure Bernat  7 , Helene Cebula  2 , Caroline le Guerinel  8 , Denis Vivien  9 , Michel Piotin  10 , Evelyne Emery  11 , Vianney Gilard  12 , Omer Eker  13 , Roberto Riva  12 , Arthur Leclerc  14 , Elsa Magro  3 , Francois Proust  2 , Isabelle Pelissou-Guyotat  4 , Stephane Derrey  12 , Sorin Aldea  8 , Charlotte Barbier  15 , Alin Borha  11 , Lawrence Nadin  15 , Anais R Briant  15 , Thomas Gaberel  16
Affiliations

The impact of primary decompressive craniectomy in ruptured middle cerebral artery aneurysms with intraparenchymal hematoma

Thomas Metayer et al. Neurochirurgie. 2025 Mar.

Abstract

Background: Ruptured middle cerebral artery aneurysm (MCAa) with intraparenchymal hematoma (IPH) can benefit at the same time from evacuation of the hematoma and exclusion of the aneurysm of a decompressive craniectomy (DC). To date, there are no clear recommendations for performing a DC in such cases.

Methods: We retrospectively collected data from nine French neurosurgical units from January 1, 2013 to December 31, 2020. All MCAa patients with IPH requiring evacuation of the IPH were included in this study. Poor outcomes were defined by an mRs score of 3-6 at 6 months. Propensity score matching was used to analyze the potential effects of DC.

Results: Between January 2013 and December 2020, 198 MCAa ruptured with IPH were treated, including 162 MCAa requiring evacuation of the IPH. 50 were treated with DC and 112 without DC. After matching 72 patients, poor neurological prognosis was observed in 27/36 patients (75%) in the DC group versus 18/36 (50%) in the non-DC group (p = 0.026).

Conclusion: Primary decompressive craniectomy in patients with ruptured MCAa and IPH requiring surgical evacuation increases the risk of poor neurological outcome. RCT are needed to confirm this hypothesis.

Keywords: Decompressive craniectomy; Hematoma; Middle cerebral artery aneurysm.

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Conflict of interest statement

Declaration of competing interest The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.