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Decompressive craniectomy following subarachnoid hemorrhage : A prospective Swedish multicenter study

Baldvinsdóttir, Bryndís LU ; Kronvall, Erik LU ; Ronne-Engström, Elisabeth ; Enblad, Per ; Klurfan, Paula ; Eneling, Johanna ; Lindvall, Peter ; Aineskog, Helena ; Friðriksson, Steen and Svensson, Mikael , et al. (2025) In Brain and Spine 5.
Abstract

Introduction: Decompressive craniectomy (DC) in patients with severe aneurysmal subarachnoid hemorrhage (aSAH) can be a life-saving procedure. The aim of this nationwide prospective study was to investigate the use of DC in aSAH patients in Sweden. Research question: To explore the risk factors and functional outcome associated with DC in patients with aSAH. Material and methods: Patients treated for aSAH at all neurosurgical centers in Sweden during a 3.5-year period (2014–2018) were prospectively registered. Clinical, radiological and treatment-related factors with regard to DC were analyzed using Chi-Square and logistic regression analysis. Functional outcome was assessed by the extended Glasgow outcome scale one year after the... (More)

Introduction: Decompressive craniectomy (DC) in patients with severe aneurysmal subarachnoid hemorrhage (aSAH) can be a life-saving procedure. The aim of this nationwide prospective study was to investigate the use of DC in aSAH patients in Sweden. Research question: To explore the risk factors and functional outcome associated with DC in patients with aSAH. Material and methods: Patients treated for aSAH at all neurosurgical centers in Sweden during a 3.5-year period (2014–2018) were prospectively registered. Clinical, radiological and treatment-related factors with regard to DC were analyzed using Chi-Square and logistic regression analysis. Functional outcome was assessed by the extended Glasgow outcome scale one year after the bleeding. Results: During the study period, 1037 patients were treated for aSAH. Thirty-five patients (3.4%) underwent DC. At one year follow-up, 25 of these (71%) had unfavorable functional outcome. Multivariate logistic regression analysis revealed that poor clinical grade before aneurysm treatment, middle cerebral artery (MCA) aneurysm, edema on the initial computed tomography (CT), and adverse events during aneurysm occlusion were independent and significant risk factors for performing DC. Discussion and conclusion: DC is relatively uncommon in aSAH patients and is related to increased risk of unfavorable outcome. However, favorable functional outcome was seen in 29% of patients with DC. Adverse events during aneurysm occlusion were significant risk factors for DC.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Adverse events, Aneurysmal subarachnoid hemorrhage, Decompressive craniectomy, Glasgow outcome scale extended, Nationwide
in
Brain and Spine
volume
5
article number
104218
publisher
Elsevier
external identifiers
  • pmid:40093033
  • scopus:85218501144
ISSN
2772-5294
DOI
10.1016/j.bas.2025.104218
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Authors
id
ee48cb5f-3f97-4a63-a14e-81ee73e7289e
date added to LUP
2025-07-03 09:09:37
date last changed
2025-07-04 03:00:08
@article{ee48cb5f-3f97-4a63-a14e-81ee73e7289e,
  abstract     = {{<p>Introduction: Decompressive craniectomy (DC) in patients with severe aneurysmal subarachnoid hemorrhage (aSAH) can be a life-saving procedure. The aim of this nationwide prospective study was to investigate the use of DC in aSAH patients in Sweden. Research question: To explore the risk factors and functional outcome associated with DC in patients with aSAH. Material and methods: Patients treated for aSAH at all neurosurgical centers in Sweden during a 3.5-year period (2014–2018) were prospectively registered. Clinical, radiological and treatment-related factors with regard to DC were analyzed using Chi-Square and logistic regression analysis. Functional outcome was assessed by the extended Glasgow outcome scale one year after the bleeding. Results: During the study period, 1037 patients were treated for aSAH. Thirty-five patients (3.4%) underwent DC. At one year follow-up, 25 of these (71%) had unfavorable functional outcome. Multivariate logistic regression analysis revealed that poor clinical grade before aneurysm treatment, middle cerebral artery (MCA) aneurysm, edema on the initial computed tomography (CT), and adverse events during aneurysm occlusion were independent and significant risk factors for performing DC. Discussion and conclusion: DC is relatively uncommon in aSAH patients and is related to increased risk of unfavorable outcome. However, favorable functional outcome was seen in 29% of patients with DC. Adverse events during aneurysm occlusion were significant risk factors for DC.</p>}},
  author       = {{Baldvinsdóttir, Bryndís and Kronvall, Erik and Ronne-Engström, Elisabeth and Enblad, Per and Klurfan, Paula and Eneling, Johanna and Lindvall, Peter and Aineskog, Helena and Friðriksson, Steen and Svensson, Mikael and Alpkvist, Peter and Hillman, Jan and Nilsson, Ola G.}},
  issn         = {{2772-5294}},
  keywords     = {{Adverse events; Aneurysmal subarachnoid hemorrhage; Decompressive craniectomy; Glasgow outcome scale extended; Nationwide}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Brain and Spine}},
  title        = {{Decompressive craniectomy following subarachnoid hemorrhage : A prospective Swedish multicenter study}},
  url          = {{http://dx.doi.org/10.1016/j.bas.2025.104218}},
  doi          = {{10.1016/j.bas.2025.104218}},
  volume       = {{5}},
  year         = {{2025}},
}