Decompressive hemicraniectomy with or without clot evacuation for large spontaneous supratentorial XXXX .

@entity1 @entity1410 @entity1779 @entity772
OBJECTIVE: The management of @entity1 with supra-tentorial @entity1779 ( @entity1779 ) remains controversial. Here we critically evaluate the safety, feasibility, and outcomes following decompressive hemicraniectomy (HC) with or without clot evacuation in the management of @entity1 with large ICHs. METHODS: We analyzed data from 73 consecutive @entity1 managed with a HC for a spontaneous @entity1779 . All relevant @entity1 variables at initial presentation and management were compiled. Variables were modeled as independent regressors against the three-month Glasgow Outcome Score using a multivariate logistic regression model. RESULTS: Over 7 years, HC was performed in 73 @entity1 with clot evacuation in 86% and HC alone in 14%. The average @entity1779 volume was 81cc and the median HC surface area was 105cm(2). 26 @entity1 were @entity772 at initial presentation. Three-month functional outcomes were favorable in 29%, unfavorable in 44% and 27% of @entity1 expired. Admission Glasgow @entity772 Scale (p=0.003), dominant hemisphere @entity1779 location (p=0.01) and @entity1410 volume (p=0.002) contributed significantly to the outcome, as estimated by a multivariate analysis. Eight surgical complications occurred. CONCLUSIONS: Early HC with or without clot evacuation is feasible and safe for managing spontaneous @entity1779 . Our experience in this uncontrolled retrospective series, the largest such series in the modern era, suggests that it may be of particular benefit in @entity1 with large non-dominant hemisphere @entity1779 who are not moribund at presentation. Our findings suggest that a prospective randomized trial of HC vs. craniotomy for @entity1779 be conducted.
