中风后症状性脑出血（sICH）是一种破坏性的神经并发症。目前的指南支持去骨瓣减压术 (DC) 对于具有显着占位效应的大型幕上 sICH 具有“可能的益处”。作者对 8 个综合性卒中中心进行了回顾性研究。他们纳入了 2016 年 1 月至 2020 年 12 月期间急性缺血性中风 (AIS) 后持续发生 sICH 的患者，根据中风监测研究中安全实施溶栓研究 (SITS-MOST) 的定义。他们将接受 DC 的患者与接受 DC 治疗的患者进行了比较。接受标准医疗治疗以测量 90 天的功能结果，主要根据改良兰金量表 (mRS) 定义，其次根据格拉斯哥结果量表扩展 (GOS-E) 定义。共确定了 85 名患者，其中 26 名是其中 (30.5%) 接受了 DC。接受 DC 的患者更年轻（58 岁 [DC] vs 76 岁 [无 DC]，p < 0.001）。没有既往有癌症病史的患者接受 DC 治疗（n = 14，p = 0.004）。 DC 组中有 25 名患者 (96.2%) 接受了血栓切除术，而非 DC 组中有 54 名患者 (91.5%) 接受了血栓切除术 (p = 0.443)。接受 DC 的患者 ICU 住院时间较长（中位 [IQR] 240 [38-408] 小时，而非 DC 患者为 24 [5-96] 小时，p = 0.002）。 90 天时，3 名患者 (4.1%) 的 mRS 评分为 0-2，10 名患者 (11.7%) 的 mRS 评分为 0-3。功能结果改善的患者更年轻（mRS 评分，OR 1.06，95% CI 1.01-1.10，p = 0.012）。有癌症病史的患者 90 天 mRS 评分较差（OR 8.49，95% CI 1.54-159，p = 0.046）。非 DC 队列中的院内死亡率或出院至临终关怀中心的比率显着较高（DC 队列中有 10 名患者 [38.5%]，而非 DC 队列中有 38 名患者 [64.4%]，p = 0.026）。 90 天后，接受 DC 治疗的患者更有可能获得改善的结果（mRS 平均等级 30.0 与 40.0，p = 0.027）。在多变量分析中，癌症病史（OR 12.2，95% CI 1.26-118，p = 0.031）和年龄较大（OR 1.07，95% CI 1.02-1.13，p = 0.011）增加了 mRS 结果较差的几率，而 DC 则增加了不是（OR 1.34，95% CI 0.357-5.03，p = 0.665）。根据多变量分析，sICH 后的 DC 并没有改善 90 天的功能结果，尽管年龄较小和没有既往癌症史与改善结果相关。

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.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-Extended (GOS-E).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 < 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 [38-408] hours vs 24 [5-96] hours in non-DC patients, p = 0.002). At 90 days, 3 patients (4.1%) had obtained an mRS score of 0-2 and 10 patients (11.7%) an mRS score of 0-3. Patients who had improved functional outcome were younger (mRS score, OR 1.06, 95% CI 1.01-1.10, p = 0.012). Patients with a history of cancer had worse 90-day mRS scores (OR 8.49, 95% CI 1.54-159, 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 1.26-118, p = 0.031) and older age (OR 1.07, 95% CI 1.02-1.13, p = 0.011) increased the odds of worse mRS outcomes while DC did not (OR 1.34, 95% CI 0.357-5.03, p = 0.665).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.