Hydrocephalus following decompressive craniectomy for malignant middle cerebral artery infarction

Lee, Ming-Hsueh; Yang, Jen-Tsung; Weng, Hsu–Huei; Cheng, Yufang; Su, Chen-Hsing; Chang, Chia-Mao; Wang, Ting‐Chung

doi:10.1016/j.clineuro.2011.11.027

Cited by 27 publications

(22 citation statements)

References 20 publications

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“…Furthermore, 62% of patients developed an extra-axial fluid collection, even though half of them had no ventricular drainage [86]. Delayed hydrocephalus, however, is a common phenomenon following stroke and has occurred in up to 30 or 47.8% of patients, respectively [87,88]. The presence of pre-, or post-cranioplasty hydrocephalus might have negative effects on the neurological outcome and could be associated with a craniectomy limit <2.5 cm from the midline [89].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

Zweckberger¹,

Jüettler

Bösel

et al. 2014

Cerebrovasc Dis

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Background: Space-occupying malignant stroke of the middle cerebral artery (MCA) is associated with a high mortality rate of up to 80% under conservative treatment. Although there is convincing evidence that decompression craniectomy can significantly reduce mortality rate and improve neurological outcome in young patients (<60 years), many surgeons are still hesitant to recommend hemicraniectomy for stroke patients. Summary: This review addresses some major issues that appear to be an obstacle to decompression craniectomy, in particular, indicating surgery for patients >60 years or with infarcts of the dominant hemisphere. Furthermore, it emphasizes technical issues such as timing and size of the craniectomy, additional temporal lobectomy, and resection of the temporal muscle, as well as duraplasty and cranioplasty. According to the current literature, decompression craniectomy in older patients can increase survival without most severe disabilities, although, most survivors need assistance in most bodily needs. Involvement of the dominant hemisphere results in aphasia that might partly recover in younger patients, although, considering the neuropsychological deficits caused by infarctions of the nondominant hemisphere, involvement of the dominant hemisphere does not pose as a contraindication for decompression craniectomy. Furthermore, there is convincing evidence that surgery should be performed within 48 h after the onset of symptoms and the size of the craniectomy should be at least 12 cm as a minimum. An additional lobectomy or the resection of the temporal muscle, however, can only be part of individual treatment options. Conceding the weak evidence, it is recommended to close the dura by some form of a duraplasty avoiding cerebrospinal fluid leakages or scarring between the cortex and the scalp leading to injuries during reimplantation of the bone-flap. Complications associated with decompression surgery (hemorrhages, infections, ‘sinking skin-flap syndrome', cerebrospinal fluid leakages, hydrocephalus, seizures), with the infarction itself, or with those that occur during the ICU course (cardiac and pulmonary complications) appear acceptable and are mostly treatable, especially considering the fatal course of conservative treatment. Key Message: This review summarizes the current state of the literature about decompression craniectomy of patients with malignant stroke addressing, in particular, critical surgical issues, and thus, help surgeons to make decisions confidently for/or against performing surgery.

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Section: Surgical Treatmentmentioning

confidence: 99%

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

Zweckberger¹,

Jüettler

Bösel

et al. 2014

Cerebrovasc Dis

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“…The beneficial effect of DC in reducing ICP has been well-documented in several studies. However, several delayed complications of DC have been reported, including sinking flap syndrome, extra-axial fluid collection, hydrocephalus, and the development of subdural hematomas 3,4. Hydrocephalus is a common complication after DC.…”

mentioning

confidence: 99%

Impact of operation details on hydrocephalus after decompressive craniectomy

Wang

Zhou

et al. 2016

NSJ

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Objective:To evaluate the correlation between the distance of craniectomy from the midline and hydrocephalus after DC.Methods:The following electronic databases were searched from their inception to June 2015: Cochrane Library, MEDLINE, Science Direct, EMBASE, Scopus, Google Scholar, the Chinese Biomedical Database (CBM), and the Chinese National Knowledge Infrastructure (CNKI). All randomized clinical trials, prospective cohort, retrospective observational cohort, and case-control studies investigating the relationship between distance of craniectomy from the midline and hydrocephalus after DC were enrolled. The Cochrane Collaboration’s software RevMan 5.3 was used for meta-analysis.Results:Six retrospective cohort studies involving 462 participants were included. Pooled analysis of 4 studies suggested that craniectomy close to the midline (<25 mm) was associated with a significantly increased risk of postoperative hydrocephalus (odds ratio [OR] = 3.61, 95% confidence interval [CI]: 1.3 - 9.97, p=0.01). However, meta-analysis of 4 studies did not find statistical differences when comparing the distance of craniectomy from the midline in the hydrocephalus group and that in the non-hydrocephalus group (OR = −0.14, 95% CI: −0.44 - 0.15, p=0.34).Conclusions:Available evidence was insufficient to support the theory that craniectomy close to the midline increases the risk of developing hydrocephalus after DC. Well-conducted randomized clinical trials are required to verify this issue.

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“…All 13 patients in our study got post-decompressive ventricular dilatation comparing with preoperative brain-CT In recent years there are two studies to report the association between post-decompressive hydrocephalus and clinical neurological expression (11,15 In our study, permanent CSF diversion surgery was done in four patients with persisted ventricular dilatation on serial brain-CT scans and unexplainable neurological deficit after bone flap placement. After shunt placement, there was no obvious improvement of neurological function or level of consciousness over these four patients and two of them complicated with subdural effusion on the side contralateral to the DC.…”

Section: Discussionmentioning

confidence: 99%

“…However, the certainty of DC itself as the major cause of hydrocephalus is still questionable due to appearance of variable confounding factors in patients with severe TBI. In recent years, the role of hydrocephalus after DC for patients with malignant MCA/ICA infarction or large hypertensive ICH got being discussed by some studies (11,15,18,19,21). Most of them focused on radiographic finding but not influence on clinical outcome.…”

Section: Lin Bj Et Al: Hydrocephalus After Decompressive Craniectomymentioning

confidence: 99%

Role of post-decompressive hydrocephalus in patients with malignant cerebral infarction

Lin

Chou²,

Feng³

et al. 2014

Turkish Neurosurgery

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AIm:The association between post-decompressive hydrocephalus and clinical neurological expression is still unclear. In order to investigate this relationship, the authors analyze series of ventricular morphology and level of consciousness at different clinical stages for patients accepting decompressive craniectomy (DC). results: All 13 patients had ventricular dilatation and two of them had extra-axial CSF collection. Restoration of ventricular dilatation was not observed in all patients after bone flap placement, but extra-axial CSF collection resorbed spontaneously. Four patients accepting permanent CSF diversion had no improvement over neurological expression. Otherwise, two of them complicated with subdural effusion after shunt placement.COnClusIOn: Decompressive craniectomy itself would lead to ventricular dilatation universally. There is no direct association between degree of ventriculomegaly and neurological expression. Permanent CSF diversion surgery as treatment for ventriculomegaly makes no clinical improvement with possible complications of overshunting.

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Hydrocephalus following decompressive craniectomy for malignant middle cerebral artery infarction

Cited by 27 publications

References 20 publications

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

Impact of operation details on hydrocephalus after decompressive craniectomy

Role of post-decompressive hydrocephalus in patients with malignant cerebral infarction

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