{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T11:51:12Z","timestamp":1779105072235,"version":"3.51.4"},"reference-count":17,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Symptomatic intracerebral hemorrhage (sICH) after stroke is a devastating neurological complication. Current guidelines support a \"possible benefit\" of decompressive craniectomy (DC) for large supratentorial sICH with significant mass effect.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors conducted a retrospective study of 8 comprehensive stroke centers. They included all patients who sustained an sICH after acute ischemic stroke (AIS), as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST), from January 2016 to December 2020. They compared patients who underwent DC to those who were treated with standard medical treatment to measure functional outcome at 90 days, primarily as defined by the modified Rankin Scale (mRS) and secondarily by the Glasgow Outcome Scale\u2013Extended (GOS-E).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Eighty-five patients were identified, 26 of whom (30.5%) underwent DC. Patients who underwent DC were younger (58 years [DC] vs 76 years [no DC], p &lt; 0.001). No patient with a previous history of cancer underwent DC (n = 14, p = 0.004). Twenty-five patients (96.2%) in the DC group underwent thrombectomy versus 54 (91.5%) in the non-DC group (p = 0.443). Patients who underwent DC had a longer ICU stay (median [IQR] 240 [38\u2013408] hours vs 24 [5\u201396] hours in non-DC patients, p = 0.002). At 90 days, 3 patients (4.1%) had obtained an mRS score of 0\u20132 and 10 patients (11.7%) an mRS score of 0\u20133. Patients who had improved functional outcome were younger (mRS score, OR 1.06, 95% CI 1.01\u20131.10, p = 0.012). Patients with a history of cancer had worse 90-day mRS scores (OR 8.49, 95% CI 1.54\u2013159, p = 0.046). The rate of in-hospital mortality or discharge to hospice was significantly higher in the non-DC cohort (10 [38.5%] patients in the DC cohort vs 38 [64.4%] in the non-DC cohort, p = 0.026). Ninety days later, patients who underwent DC were more likely to have improved outcome (mRS mean rank 30.0 vs 40.0, p = 0.027). In multivariable analysis, history of cancer (OR 12.2, 95% CI 1.26\u2013118, p = 0.031) and older age (OR 1.07, 95% CI 1.02\u20131.13, p = 0.011) increased the odds of worse mRS outcomes while DC did not (OR 1.34, 95% CI 0.357\u20135.03, p = 0.665).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>DC after sICH did not improve functional outcome at 90 days according to multivariable analysis, although younger age and absence of previous cancer history were associated with improved outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.4.jns24318","type":"journal-article","created":{"date-parts":[[2024,7,27]],"date-time":"2024-07-27T01:36:13Z","timestamp":1722044173000},"page":"1-10","source":"Crossref","is-referenced-by-count":2,"title":["Decompressive craniectomy in symptomatic intracerebral hemorrhage after ischemic stroke: a multicenter retrospective cohort study"],"prefix":"10.3171","author":[{"given":"Elliot","family":"Pressman","sequence":"first","affiliation":[{"name":"Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary C.","family":"Gersey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soren B.","family":"Jonzzon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua H.","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Ohio State University, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David N.","family":"Fogg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily G.","family":"Flaherty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley A.","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohan V.","family":"Chitale","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew R.","family":"Fusco","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael T.","family":"Froehler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Vignolles-Jeong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Ohio State University, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahid M.","family":"Nimjee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Ohio State University, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo A.","family":"Hanel","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo M.","family":"Cortez","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saisree","family":"Ravi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Valley Baptist Medical Center, Harlingen, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sohum K.","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Valley Baptist Medical Center, Harlingen, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ameer E.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Valley Baptist Medical Center, Harlingen, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andre","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University at Buffalo, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adnan H.","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University at Buffalo, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stavros","family":"Matsoukas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahram","family":"Majidi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teagen","family":"Smith","sequence":"additional","affiliation":[{"name":"Research Methodology and Biostatistics Core, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunal","family":"Vakharia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxim","family":"Mokin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10029","key":"b1","series-title":"Lancet","first-page":"1723","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised 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