Assessment of Early Outcomes Following Decompressive Craniectomy with Hematoma Evacuation for SpontaneousSupratentorial Deep-Seated Intracerebral Hemorrhage

Open Access

Abstract

Background: Spontaneous deep-seated supratentorial intracerebral hemorrhage (ICH) is associated with high mortality and substantial neurological disability. The role of surgical treatment, particularly decompressive craniectomy combined with hematoma evacuation, remains uncertain because of the risk of additional injury to deep eloquent structures and limited evidence regarding its clinical and radiological benefits. This study aim was to assess the early clinical and radiological outcomes of decompressive craniectomy with hematoma evacuation in patients with spontaneous supratentorial deep-seated intracerebral hemorrhage. Methods & Materials: This prospective study included 18 patients with spontaneous supratentorial deep-seated ICH treated at Dhaka Medical College Hospital from October 2022 to March 2024. Patients met predefined clinical and radiological criteria and underwent decompressive craniectomy with hematoma evacuation. Pre- and postoperative GCS, midline shift, and 30-day functional outcomes were assessed using the Glasgow Outcome Scale. Data were analyzed using SPSS 27.0. Results: The mean age was 55.39 ± 11.55 years, with 77.8% male patients. Hypertension and diabetes were present in 94.4% and 66.7%, respectively. Mean hematoma volume was 59.88 ± 20.21 mL and preoperative GCS was 8.61 ± 1.78. Postoperatively, GCS improved to 9.22 ± 2.77, while midline shift decreased from 10.12 to 5.70 mm. Functional survival occurred in 50.0% of patients, while mortality was 44.4%. Conclusion: Decompressive craniectomy with hematoma evacuation was followed by improvement in neurological status and substantial reduction in midline shift in this cohort. Functional survival was observed in half of the patients, while mortality remained considerable. These findings suggest that this surgical approach may be a feasible option for carefully selected patients with severe deep-seated ICH.