Decompressive hemicraniectomy after subarachnoid haemorrhage – justifiable in light of long-term outcome?
Brain and Spine, vol. 1, pp. 100347
Abstract
treated by immediate induction to systolic values above 180mmHg (iHT-N imm ).Both groups were compared concerning the need for additional endovascular rescue treatment, the occurrence of DCI caused infarction and clinical outcome assessed by the extended Glasgow outcome scale after 12 months.Results: The rate of refractory DCI requiring additional rescue therapy was comparable in both groups (48.9% in iHTN incr , 40% in iHTN imm ; p¼0.332).However, immediate induction was associated with a significantly lower risk of DCI induced infarction (29.5% vs. 51.1%;p¼0.015).This is also reflected in a trend towards a higher rate of favorable outcome as measured by the GOSE after 12 months in the iHTN imm group.(60.5% vs. 45.2%;p¼0.110).Conclusion: In this observational trial, initial aggressive elevation of blood pressure was associated with a lower rate of DCI induced infarction and better outcome when compared to an incremental adjustment of blood pressure, possibly due to a more timely compensation of misery perfusion.Future studies will have to determine the additional value of more detailed approaches such as optimal cerebral perfusion pressure (CPP opt ) in the treatment of delayed cerebral ischemia.
Authors 5
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Michael Veldeman Aachen
Affiliation as printed
Universitätsklinikum Aachen, Neurosurgery, Aachen, Germany
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Miriam Weiss Aachen
Affiliation as printed
Universitätsklinikum Aachen, Neurosurgery, Aachen, Germany
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Walid Albanna Aachen
Affiliation as printed
Universitätsklinikum Aachen, Neurosurgery, Aachen, Germany
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Hans Clusmann Aachen
Affiliation as printed
Universitätsklinikum Aachen, Neurosurgery, Aachen, Germany
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G. Schubert Alexander Aachen
Affiliation as printed
Universitätsklinikum Aachen, Neurosurgery, Aachen, Germany
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