Hemicraniectomy for large middle cerebral artery territory infarction: outcome in 19 patients

Pranesh, M B; Nayak, Sanjeev; Mathew, Verghese; B, Prakash; Natarajan, Madhu K.; Rajmohan, V; Murali, Raj; Pehlaj, A

doi:10.1136/jnnp.74.6.800

Cited by 42 publications

(31 citation statements)

References 20 publications

(13 reference statements)

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“…Patients who received decompressive craniectomy had mean BI of 53.3 and RS of 3.3. Our results accorded with data published by Pranesh et al(2003) and Schwab et al(1998). It was often thought that decompressive craniectomy must be offered only to patients with non-dominant hemispherical strokes because the speech function is unaffected and outcome would be better (Carter et al, 1997).…”

Section: Discussionsupporting

confidence: 82%

Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth?

Yang¹,

Yu²,

Hu³

et al. 2005

J. Zhejiang Univ. Sci.

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Abstract:Objective: Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%. The aim of this study was to determine the value of decompressive craniectomy in patients presenting malignant MCA infarction compared with those receiving medical treatment alone. Methods: Patients with malignant MCA infarction treated in our hospital between January 1996 and March 2004 were included in this retrospective analysis. The National Institute of Health Stroke Scale (NIHSS) was used to assess neurological status on admission and at one week after surgery. All patients were followed up for assessment of functional outcome by the Barthel index (BI) and modified Rankin Scale (RS) at 3 months after infarction. Results: Ten out of 24 patients underwent decompressive craniectomy. The mean interval between stroke onset and surgery was 62.10 h. The mortality was 10.0% compared with 64.2% in patients who received medical treatment alone (P<0.001). The mean NIHSS score before surgery was 26.0 and 15.4 after surgery (P<0.001). At follow up, patients who underwent surgery had significantly better outcome with mean BI of 53.3, RS of 3.3 as compared to only 16.0 and 4.60 in medically treated patients. Speech function also improved in patients with dominant hemispherical infarction. Conclusion: Decompressive craniectomy in patients with malignant MCA infarction improves both survival rates and functional outcomes compared with medical treatment alone. A randomized controlled trial is required to substantiate those findings.

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Section: Discussionsupporting

confidence: 82%

Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth?

Yang¹,

Yu²,

Hu³

et al. 2005

J. Zhejiang Univ. Sci.

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“…[3][4][5] After hemicraniectomy, the Barthel Index was reported to vary from 56% to 65% in unselected patients with middle cerebral artery territory stroke. 3,5,6 Clinical observations suggest that the long-term quality of life and the functional outcome of rehabilitation in surviving patients may significantly improve after hemicraniectomy. Presently, to our knowledge there is no existing randomized prospective trial of patients with spaceoccupying infarctions in evaluation of functional outcome.…”

mentioning

confidence: 99%

Recovery From Aphasia After Hemicraniectomy for Infarction of the Speech-Dominant Hemisphere

Kastrau

Wolter

Huber

et al. 2005

Stroke

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Background and Purpose-The space-occupying effect of cerebral edema limits survival chances of patients with severe ischemic stroke. Besides conventional therapies to reduce intracranial pressure, hemicraniectomy can be considered as a therapeutic option after space-occupying cerebral infarction. There is controversy regarding the use of this method in patients with infarction of the speech-dominant hemisphere. Methods-In 14 patients with infarction of the dominant hemisphere and subsequent treatment with hemicraniectomy, recovery from aphasic symptoms was evaluated retrospectively. A group of patients who were treated between 1994 and 2003 in our aphasia ward was selected for the study. In all patients, a psychometric quantification was accomplished applying the Aachen Aphasia Test at least twice within a mean observation period of 470 days. Results-A significant improvement of the statistical parameters representing different aspects of aphasia was observed in 13 of 14 patients. Also, an increase of the ability to communicate was evident in 13 patients. Young age at the time of stroke and early poststroke decompressive surgery were identified as main predictors for recovery from aphasia. Conclusions-A significant improvement of aphasic symptoms can be observed in a preselected group of patients after a massive stroke of the speech-dominant hemisphere treated by consecutive hemicraniectomy. Therefore, decompressive surgery can be considered for the treatment of this kind of stroke. Key Words: aphasia Ⅲ cerebral infarction Ⅲ craniotomy Ⅲ recovery of function T he majority of stroke patients with space-occupying supratentorial infarctions have a fatal outcome. Conservative therapy of brain edema and consecutive transtentorial brain herniation is confined to hyperventilation, osmotherapy, barbiturate, and tris(hydroxymethyl)aminomethan buffer infusions. Despite this treatment, mortality of patients is up to 80%. 1 Frequently, removal of a bone flap and opening of the dura to relieve pressure and prevent transtentorial and uncal herniation can be appropriate life-saving procedures. This technique was first applied in 1905, 2 and since 1950, it was more frequently reported in the context of therapy of spaceoccupying infarction. Besides the improvement of cerebral perfusion, hemicraniectomy protects against herniation and may lower the mortality of stroke patients. Recent studies have shown that decompressive hemicraniectomy can decrease mortality to 21% to 35%. 3-5 After hemicraniectomy, the Barthel Index was reported to vary from 56% to 65% in unselected patients with middle cerebral artery territory stroke. 3,5,6 Clinical observations suggest that the long-term quality of life and the functional outcome of rehabilitation in surviving patients may significantly improve after hemicraniectomy. Presently, to our knowledge there is no existing randomized prospective trial of patients with spaceoccupying infarctions in evaluation of functional outcome.A series of factors is likely to affect long-term functional outcome ...

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“…Em nosso estudo a taxa de mortalidade com o uso da craniectomia descompressiva foi 26%, sendo inferior à descrita na literatura para o tratamento conservador dos IEIE´s, a qual se situa entre 70-80% 20 . Existem relatos de resultado funcional pobre e aumento da mortalidade em pacientes mais idosos que se submeteram à craniectomia descompressiva 5,20 .…”

Section: Discussionunclassified

“…Existem relatos de resultado funcional pobre e aumento da mortalidade em pacientes mais idosos que se submeteram à craniectomia descompressiva 5,20 . Tal fato pode ser explicado pelos seguintes fatores: a idade mais avançada (acima de 50 anos) pode ter um efeito na habilidade do cérebro em compensar os efeitos de um AVC e, além disso, esses pacientes tendem a ter comorbidades adicionais que provavelmente aumentam o risco de um prognóstico ruim e óbito 5,6 .…”

Section: Discussionunclassified

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Craniectomia descompressiva para tratamento de hipertensão intracraniana secundária a infarto encefálico isquêmico extenso: análise de 34 casos

Nobre¹,

Monteiro

Albuquerque³

et al. 2007

Arq. Neuro-Psiquiatr.

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RESUMO -Infarto encefálico isquêmico extenso (IEIE) é a perda do suprimento sangüíneo de uma grande área cerebral, principalmente do território da artéria cerebral média. Pode evoluir com edema importante, hipertensão intracraniana e óbito em até 80% dos casos. Objetivo: Avaliar os resultados da craniectomia descompressiva no tratamento da hipertensão intracraniana secundária ao IEIE, comparando com os resultados de outros estudos publicados na literatura. Método: Foram analisados 34 pacientes com IEIE tratados clinicamente sem sucesso e que necessitaram de craniectomia descompressiva para controle da hipertensão intracraniana. Resultados: 8 pacientes (23,52%) faleceram, 26 (76,47%) sobreviveram, sendo que 2 (7,70%) permaneceram em estado vegetativo. Conclusão: Os fatores idade acima de 50 anos e sexo masculino se associaram a maior risco de evolução para óbito. O nível de consciência à admissão e a área do retalho ósseo apresentaram valores próximos de significância estatística. PALAVRAS-CHAVE: edema cerebral, infarto cerebral, craniectomia descompressiva.Decompressive craniectomy for treatment of intracranial hypertension secondary to large ischemic cerebral infarction: analysis of 34 cases ABSTRACT -The large ischemic cerebral infarction (LICI) is a brain supply loss of a large area in the brain, mainly on the middle cerebral artery. Is possible that evolutes a major edema, intracranial hypertension and death in about 80% of the cases. Objective: To avaliate the results of a descompressive craniectomy on the treatment of the secundary intracranial hypertension to LICI, comparing to other results of medical literature already published. Method: Were analysed 34 pacients diagnosed with LICI clinically treated unsuccesfully that needed forther on the decompressive craniectomy treatment, for the control of intracranial hypertension. Results: 8 pacients (23.52%) died, 26 (76.47%) survived, and 2 (7.70%) developed a vegetative state condition. Conclusion: The factors age over 50 years and male gender were associated with a high death risk. The level of consciousness at admission and bone flap area were nearer the values of statistic significance.KEY WORDS: brain edema, cerebral infarction, decompressive craniectomy.Infarto encefálico isquêmico extenso (IEIE) é a perda do suprimento sanguíneo em grande área do encéfalo, acometendo principalmente a área irrigada pela artéria cerebral média (ACM) 1 . Ocorre em cerca de 10% dos acidentes vasculares cerebrais isquêmicos (AVCI) 1 . Os IEIEs podem evoluir com edema grave, hipertensão intracraniana (HIC) e óbito em 80% dos casos, apesar do tratamento conservador, justificando a denominação de infarto maligno [1][2][3][4] . Sinais clínicos e radiológicos como hipodensidade precoce em mais de 50% do território irrigado pela ACM ou volume do infarto à tomografia computadorizada (TC) igual ou superior a 240 cm 3 são sugestivos de evolução para infarto maligno 1,3,5 . Em geral os pacientes com IEIE

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Hemicraniectomy for large middle cerebral artery territory infarction: outcome in 19 patients

Cited by 42 publications

References 20 publications

Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth?

Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth?

Recovery From Aphasia After Hemicraniectomy for Infarction of the Speech-Dominant Hemisphere

Craniectomia descompressiva para tratamento de hipertensão intracraniana secundária a infarto encefálico isquêmico extenso: análise de 34 casos

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