Decompressive hemicraniectomy with or without clot evacuation for large spontaneous supratentorial intracerebral hemorrhages

Yoshua Esquenazi, Sean I. Savitz, Ramy El Khoury, Megan A. McIntosh, James C. Grotta, Nitin Tandon

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Objective The management of patients with supra-tentorial intracerebral hemorrhage (ICH) remains controversial. Here we critically evaluate the safety, feasibility, and outcomes following decompressive hemicraniectomy (HC) with or without clot evacuation in the management of patients with large ICHs.

Methods We analyzed data from 73 consecutive patients managed with a HC for a spontaneous ICH. All relevant patient 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 patients with clot evacuation in 86% and HC alone in 14%. The average ICH volume was 81 cc and the median HC surface area was 105 cm2. 26 patients were comatose at initial presentation. Three-month functional outcomes were favorable in 29%, unfavorable in 44% and 27% of patients expired. Admission Glasgow Coma Scale (p = 0.003), dominant hemisphere ICH location (p = 0.01) and hematoma 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 ICH. Our experience in this uncontrolled retrospective series, the largest such series in the modern era, suggests that it may be of particular benefit in patients with large non-dominant hemisphere ICH who are not moribund at presentation. Our findings suggest that a prospective randomized trial of HC vs. craniotomy for ICH be conducted.

Original languageEnglish (US)
Pages (from-to)117-122
Number of pages6
JournalClinical Neurology and Neurosurgery
StatePublished - Jan 2015
Externally publishedYes


  • Cerebral edema
  • Craniectomy
  • Hypertensive hemorrhage
  • Intracerebral hematoma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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