Clinical Neurology and Neurosurgery 135 (2015) 15–21
Contents lists available at ScienceDirect
Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro
The bigger, the better? About the size of decompressive hemicraniectomies L. Tanrikulu a , A. Oez-Tanrikulu b , C. Weiss c , T. Scholz a , J. Schiefer d , H. Clusmann a , G.A. Schubert a,∗ a
Department of Neurosurgery, RWTH Aachen University, Aachen, Germany Department of Ophthalmology, St. Martinus-Hospital Düsseldorf, Düsseldorf, Germany c Institute for Biomedical Statistics, Universitätsmedizin Mannheim, University of Heidelberg, Heidelberg, Germany d Department of Neurology, RWTH Aachen University, Aachen, Germany b
a r t i c l e
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Article history: Received 13 January 2015 Received in revised form 2 March 2015 Accepted 25 April 2015 Available online 5 May 2015 Keywords: Decompressive hemicraniectomy Craniectomy size Traumatic brain injury Subarachnoid hemorrhage Malignant stroke
a b s t r a c t Introduction: Decompressive hemicraniectomy (DHC) is a treatment option in refractory ICP elevation and malignant infarction. A minimum diameter of 12 cm has been widely accepted as mandatory for effective decompression for ICP control. Complete hemispheric exposure is frequently advocated to further reduce the risk of parenchymal shear stress, hemorrhage and swelling. At the same time, superior efficacy and comparable risk profile of a more extensive decompression have yet to be established. Material and methods: We reviewed 74 patients with comprehensive clinical data sets undergoing DHC from 2008 to 2013 at our institution. With a minimum threshold of 12 cm in AP diameter being observed in all cases, patients were grouped according to the absolute size of maximum AP diameter (
Contents lists available at ScienceDirect
Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro
The bigger, the better? About the size of decompressive hemicraniectomies L. Tanrikulu a , A. Oez-Tanrikulu b , C. Weiss c , T. Scholz a , J. Schiefer d , H. Clusmann a , G.A. Schubert a,∗ a
Department of Neurosurgery, RWTH Aachen University, Aachen, Germany Department of Ophthalmology, St. Martinus-Hospital Düsseldorf, Düsseldorf, Germany c Institute for Biomedical Statistics, Universitätsmedizin Mannheim, University of Heidelberg, Heidelberg, Germany d Department of Neurology, RWTH Aachen University, Aachen, Germany b
a r t i c l e
i n f o
Article history: Received 13 January 2015 Received in revised form 2 March 2015 Accepted 25 April 2015 Available online 5 May 2015 Keywords: Decompressive hemicraniectomy Craniectomy size Traumatic brain injury Subarachnoid hemorrhage Malignant stroke
a b s t r a c t Introduction: Decompressive hemicraniectomy (DHC) is a treatment option in refractory ICP elevation and malignant infarction. A minimum diameter of 12 cm has been widely accepted as mandatory for effective decompression for ICP control. Complete hemispheric exposure is frequently advocated to further reduce the risk of parenchymal shear stress, hemorrhage and swelling. At the same time, superior efficacy and comparable risk profile of a more extensive decompression have yet to be established. Material and methods: We reviewed 74 patients with comprehensive clinical data sets undergoing DHC from 2008 to 2013 at our institution. With a minimum threshold of 12 cm in AP diameter being observed in all cases, patients were grouped according to the absolute size of maximum AP diameter (
