Decompressive hemicraniectomy in patients with malignant middle cerebral artery infarction: A real-world study

Pilato, Fabio; Pellegrino, Giovanni; Calandrelli, Rosalinda; Broccolini, Aldobrando; Marca, Giacomo Della; Frisullo, Giovanni; Morosetti, Roberta; Profice, Paolo; Brunetti, Valerio; Capone, Fioravante; D’Apolito, Gabriella; Quinci, Vincenzo; Albanese, Alessio; Mangiola, Annunziato; Marchese, Enrico; Pompucci, Angelo; Lazzaro, Vincenzo Di

doi:10.1016/j.jns.2022.120376

Cited by 4 publications

(6 citation statements)

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“…In the CVO group, the GCS score was approximately 3 (3-3) and the midline shift was 13.07±3.98 mm. Postoperatively, the GCS score in the ASH group was approximately 15 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and the midline shift was 3.01±2.78 mm. In the CVO group, the GCS score was found to be approximately 3 (3-3) and the midline shift was 4.90±3.79 mm.…”

Section: Resultsmentioning

confidence: 97%

“…Additionally, 5 (45.5%) patients were found to be unconscious. Before surgery, the GCS score in the ASH group was approximately 14 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and the midline shift was 8.66±6.99 mm. In the CVO group, the GCS score was approximately 3 (3-3) and the midline shift was 13.07±3.98 mm.…”

Section: Resultsmentioning

confidence: 99%

“…10,11 Therefore, the logic of decompressive craniectomy is to prevent life-threatening cerebral/cerebellar herniation and improve cerebral perfusion by reducing intracranial pressure. 12,13 There is good evidence that surgical decompression in ischemic stroke can control intracranial hypertension, which is strongly associated with mortality. 5,13 However, in one study, no difference was found in terms of in-hospital mortality and length of hospital stay between patients who underwent surgery between 4 and 24 hours after admission and patients who underwent surgery within 4 hours.2 Depending on the size of the bone to be removed, the literature indicates that the larger the defect, the better results are achieved with a minimum bone flap diameter of 11 to 12 cm.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 There is good evidence that surgical decompression in ischemic stroke can control intracranial hypertension, which is strongly associated with mortality. 5,13 However, in one study, no difference was found in terms of in-hospital mortality and length of hospital stay between patients who underwent surgery between 4 and 24 hours after admission and patients who underwent surgery within 4 hours.2 Depending on the size of the bone to be removed, the literature indicates that the larger the defect, the better results are achieved with a minimum bone flap diameter of 11 to 12 cm. 14 Interestingly, in recent studies, it is recommended to replace the bone flap loosely after decompression in both acute subdural hematoma and stroke patients.1,15 In addition, no difference in disability and quality of life outcomes has been reported between patients with traumatic acute subdural hematoma who underwent craniotomy or decompressive craniectomy.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the decompressive craniectomy results in patients with ischemic stroke and acute subdural hematoma and determination of prognostic markers

Öğden,

Karagedik,

Erdoğan

et al. 2023

JOCS

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Aims: This study aimed to investigate the therapeutic effectiveness of decompressive craniectomy in patients with traumatic acute subdural hematoma and stroke patients and to determine the parameters that could predict the risk of mortality in these patients. Methods: Patients diagnosed and operated on with acute subdural hematoma (ASH) or stroke between January 2022 and September 2023 were grouped into the ASH group and the CVO group. The patients were also divided into DEAD and SURVIVED groups according to mortality. Age, gender, anisocoria, the area of the craniectomy field, length of stay in the intensive care unit (ICU), length of stay in the hospital, and Glasgow Outcome Scale scores were recorded. In addition, Glasgow Coma Scale (GCS) scores, the amount of midline shift, and the blood biochemistry results were recorded pre-and postoperatively. Results: This study consisted of 11 (5 male and 6 female) patients. Sex, preoperative GCS score, anisocoria, postoperative sedation anesthesia time, postoperative GCS score, duration of stay in the ICU, preoperative serum blood urine nitrogen, preoperative serum C-reactive protein (CRP), postoperative neutrophil-to-lymphocyte ratio, and postoperative CRP values were different between the ASH and CVO groups (p<0.05). Furthermore, the preoperative GCS score, postoperative GCS score, postoperative sedation anesthesia duration, postoperative serum aspartate aminotransferase (AST), and postoperative serum CRP level values were different between the DEAD and SURVIVED groups (p<0.05). The correlation analysis results revealed a positive correlation between mortality and preoperative GCS score and a negative correlation between mortality and anisocoria (p<0.05). The ROC-curve analysis revealed that preoperative GCS and postoperative GCS score, postoperative midline shift, postoperative serum AST level value, and postoperative serum CRP level value could predict mortality risk (p<0.05). However, Logistic Regression analysis showed that any study parameter could be used as the best marker for prediction of the postoperative mortality risk (p>0.05). Conclusion: This study showed that decompressive craniectomy may offer more satisfactory results in severe head trauma patients. It was also argued that preoperative and postoperative GCS scores, postoperative midline shift values, and postoperative serum AST and CRP level values could be used to predict mortality risk.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of the decompressive craniectomy results in patients with ischemic stroke and acute subdural hematoma and determination of prognostic markers

Öğden,

Karagedik,

Erdoğan

et al. 2023

JOCS

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“…Кроме того, по мнению ряда авторов, ДГК не приводит к улучшению функционального исхода пациента [23][24][25][26]. Несмотря на ограничение по возрасту (не старше 60 лет) при определении показаний к выполнению ДГК при ЗИИ [9,[26][27][28], некоторые авторы отмечают ее эффективность у пациентов старших возрастных групп [18,21,[29][30][31][32]. Операция направлена на создание большого костного дефекта черепа с последующим рассечением и пластикой твердой мозговой оболочки, что обеспечивает снижение внутричерепной гипертензии и предупреждает повреждение структур головного мозга от последствий развивающегося дислокационного синдрома [33][34][35][36].…”

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Assessment of the results of treatment of malignant middle cerebral artery infarction

Sehweil Salah,

Goncharova

2024

Nejrohirurgiâ (Mosk.)

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Background. A vast ischemic lesion in cases of malignant middle cerebral artery infarction causes a massive edema of the affected cerebral hemisphere, which leads to development of the dislocation syndrome and, in most cases, death. Decompressive hemicraniectomy is a more effective method for treatment of malignant ischemic infarction, than conservative therapy.Aim. Evaluation of the effectiveness of treatment of malignant middle cerebral artery infarction.Materials and methods. Analysis was carried out of the case histories of 57 patients with malignant middle cerebral artery infarction, out of which number 64.9 % were women and 35.1 % were men. The patients’ ages varied from 49 to 90 years, with the average of 72.7 year. All patients were divided into two groups: Group 1 patients (n = 47, 82.5 %) received only conservative therapy, while Group 2 patients (n = 10, 17.5 %) were subjected to surgical treatment.Results. The in-hospital stay of Group 1 patients varied from 2 to 73 days (the mean stay being 14.4 ± 1.8 days). Lethality in the conservative therapy patients was 46.8 % during the in-hospital stay varying from 2 to 21 days, with the average of 7.7 ± 1.7 days. Based on the postmortem examination, dislocation syndrome and its consequences were the cause of death in 90.9 % of the patients, who received in-hospital conservative therapy.The in-hospital stay of Group 2 patients varied from 22 to 33 days, with the average of 19.6 ± 4.3 days. The postoperative mortality was 40 %. The postmortem examination showed that the cause of the deaths was exacerbation of the dislocation syndrome and its consequences.Conclusion. Malignant ischemic syndrome in the territory supplied by the middle cerebral artery is the most severe form of ischemic infarction accompanied by constant disability of patients. Despite decompressive hemicraniectomy, lethality for the patients with malignant ischemic syndrome remains high, the principal cause being development of the dislocation syndrome.

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Critical Care Decisions After Large Core Cerebral Infarctions: A Secondary Analysis From the SELECT2 Trial

Kasner,

Mullen,

DeGeorgia

et al. 2024

Annals of Neurology

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ObjectiveAmong patients with large vessel occlusion (LVO) and large ischemic cores, critical decisions often need to be made about decompressive hemicraniectomy (DHC) or early withdrawal of life‐sustaining therapy (WLST). In this study, we aimed to evaluate utilization of DHC and early WLST and factors associated with them in patients with large strokes from the SELECT2 trial.MethodsWe analyzed the entire SELECT2 trial population, which randomized 352 patients with stroke due to LVO and large ischemic cores to endovascular thrombectomy (EVT) or medical management. We used the as‐treated principle to compare the use of DHC and early WLST within 7 days after randomization. We further assessed functional outcomes (modified Rankin Score) after these decisions.ResultsOf 352 patients enrolled in this study, 55 received DHC and 81 transitioned to early WLST. Patients treated with EVT were as likely to undergo DHC (16% vs 15%, adjusted relative risk [aRR] = 1.19, 95% CI:0.75–1.88, p = 0.46) or WLST (22% vs 24%, aRR = 0.94, 95% CI: 0.66–1.34, p = 0.72) as those given medical management. DHC was used more frequently in younger patients and WLST more in older patients. EVT efficacy was maintained after adjusting for DHC (adjusted generalized odds ratio [aGenOR] = 1.68, 95% CI: 1.24–2.11, p < 0.001), with no interaction between DHC and treatment (p‐interaction = 0.93). At 1 year, 21% of DHC‐treated patients were ambulatory; the outcomes were universally poor after early WLST.InterpretationIn the SELECT2 trial of patients with large ischemic core, DHC was performed in ~1 of 6 patients and early WLST in ~1 of 5 patients, without differences based on treatment with EVT or medical management, nor successful reperfusion. DHC or WLST did not detract from thrombectomy treatment benefit. Additionally, ~20% of patients achieved independent ambulation despite receiving DHC by the 1‐year follow‐up. The similar distribution of these critical care decisions provides reassurance that the overall trial outcomes were not biased by open‐label treatment allocation. ANN NEUROL 2024

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Decompressive hemicraniectomy in patients with malignant middle cerebral artery infarction: A real-world study

Cited by 4 publications

References 41 publications

Comparison of the decompressive craniectomy results in patients with ischemic stroke and acute subdural hematoma and determination of prognostic markers

Comparison of the decompressive craniectomy results in patients with ischemic stroke and acute subdural hematoma and determination of prognostic markers

Assessment of the results of treatment of malignant middle cerebral artery infarction

Critical Care Decisions After Large Core Cerebral Infarctions: A Secondary Analysis From the SELECT2 Trial

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