Background/Introduction
Decompressive hemicraniectomy (DHC) is beneficial in patients with acute ischemic stroke. However, the knowledge and benefit in hemorrhagic strokes continues to evolve. Previous studies have included cortical and subcortical intracerebral hemorrhage (SCICH) in their analysis. We report outcomes of a matched series of DHC in subcortical ICH.

Methods
We reviewed our Get-with-the-stroke guideline database and identified all patients with SCICH. Cases with SCICH with hemicraniectomy were matched with conservatively managed patients by Age (+/- 10 years), gender and ICH hematoma volume category 0-30, 30-60, >60 ml. Measured outcomes included hospital length of stay (LOS), disposition at inpatient discharge, 90-day Glasgow outcome score (GOS). 

Results
Seven SCICH cases with DC were matched with 22 patients managed conservatively without DHC. There was no difference in clinical characteristics between groups. Discharge disposition did not differ between groups. Despite a higher GOS3 at 90 days amongst DC cases, there was no significant difference between groups (71.3% vs 54.5% p=0.665). However, hospital LOS was significantly different (26.5 vs 12.5 days p=0.006).

Conclusion
DC for subcortical intracerebral hemorrhage was associated with a prolonged hospital stay. Despite improving survival there was no significant difference between groups. DC may not be effective alone in improving outcomes. Further studies in the benefit of DC in SCICH are needed.

Outcomes following Decompressive Hemicraniectomy for Subcortical Spontaneous Intracerebral Hemorrhage