Neurologic Functional Outcomes of Decompressive Hemicraniectomy Versus Conventional Treatment for Malignant Middle Cerebral Artery Infarction: A Systematic Review and Meta-Analysis

Li, Yuping; Hou, Mengzhuo; Lu, Guangyu; Ciccone, Natalia; Wang, Xingdong; Dong, Lun; Chen, Cheng; Zhang, Hengzhu

doi:10.1016/j.wneu.2016.12.069

Cited by 19 publications

(11 citation statements)

References 54 publications

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“…The literature search identified eight RCTs comparing surgical decompression with no surgical decompression, [4][5][6][7][8][9][10][11] one additional RCT published in the supplement of an individual patient data meta-analysis 3 but later published separately 12 (Supplemental Figure 1), one earlier and smaller individual patient data meta-analysis, 13 and 10 systematic reviews and meta-analyses. [17][18][19][20][21][22][23][24][25][26][27] One RCT 8 could not be included in the quantitative metaanalyses because no information was available on effects in patients in the two different age groups. 7,8,[10][11][12] In DECIMAL, DESTINY, Zhao et al, Slezins et al, and DEMITUR patients had to be treated up to 48 hours after symptom onset.…”

Section: Resultsmentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on the management of space-occupying brain infarction

Worp

Hofmeijer

Jüttler

et al. 2021

European Stroke Journal

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Space-occupying brain oedema is a potentially life-threatening complication in the first days after large hemispheric or cerebellar infarction. Several treatment strategies for this complication are available, but the size and quality of the scientific evidence on which these strategies are based vary considerably. The aim of this Guideline document is to assist physicians in their management decisions when treating patients with space-occupying hemispheric or cerebellar infarction. These Guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. A working group identified 13 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. An expert consensus statement was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high-quality evidence to recommend surgical decompression to reduce the risk of death and to increase the chance of a favourable outcome in adult patients aged up to and including 60 years with space-occupying hemispheric infarction who can be treated within 48 hours of stroke onset, and low-quality evidence to support this treatment in older patients. There is continued uncertainty about the benefit and risks of surgical decompression in patients with space-occupying hemispheric infarction if this is done after the first 48 hours. There is also continued uncertainty about the selection of patients with space-occupying cerebellar infarction for surgical decompression or drainage of cerebrospinal fluid. These Guidelines further provide details on the management of specific subgroups of patients with space-occupying hemispheric infarction, on the value of monitoring of intracranial pressure, and on the benefits and risks of medical treatment options. We encourage new high-quality studies assessing the risks and benefits of different treatment strategies for patients with space-occupying brain infarction.

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Section: Resultsmentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on the management of space-occupying brain infarction

Worp

Hofmeijer

Jüttler

et al. 2021

European Stroke Journal

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“…[ 13 , 18 , 21 ] Its use nevertheless continues to remain controversial despite a number of studies reporting positive outcomes with respect mortality and occasionally functional outcome. [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

“…The finding of increased survival at the expense of moderate-to-severe disability[ 3 ] is not universal. A meta-analysis of Chinese and English Literature found that DC resulted in decreased mortality and good functional outcome, with outcome assessed again using, inter alia, the mRS.[ 14 ] A 2011 study found that the rates of DC for MMCAI in the United States were increasing because of perceived benefits in both mortality and functional outcomes. [ 1 ] Indeed, DC is considered one of the four most effective acute interventions to reduce stroke related morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Decompressive craniotomy for malignant middle cerebral artery infarction: The quest for an African perspective

Naidoo¹

2021

Surgical Neurology International

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Background: Although associated with controversy, decompressive craniotomy (DC) for malignant middle cerebral artery infarction (MMCAI) is an unequivocally lifesaving intervention. DC for MMCAI is rarely performed in lower- to middle-income countries. Methods: A systemic review was performed in attempt to determine the rates of utilization and outcomes of DC on the African continent. Results: Only two African studies describing DC for MMCAI were found. Conclusion: DC for MMCAI is rarely performed and/or reported on the African continent. The African perspective for this needs to be urgently broadened.

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“…Exclusion criteria were: (1) imaging examination of cerebral infarction revealing ≥1/3 middle cerebral artery blood supply area; (2) recent intracranial hemorrhage or a history of bleeding tendency; (3) contraindications for endovascular treatment, including allergy to contrast media; (4) intravenous or intra-arterial thrombolysis alone; (5) severe damage to liver and kidney function; (6) other causes of intracranial stenosis, including vasculitis and cerebral vasospasm etc. ; (7) severe cerebral infarction (NIHSS score of dominant hemispheric infarction >20 points or NIHSS score of non-dominant hemisphere infarction >15 points) [14,15].…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Safety and efficacy of intravascular therapy in patients with progressive stroke caused by intracranial large vascular occlusion exceeding the time window of 24 hours

Zhang

Chen

et al. 2021

Neurological Research

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Purpose: To compare endovascular and drug therapies for efficacy and safety in patients with a progressive stroke caused by intracranial large vascular occlusion exceeding the time window of 24 hours. Patients and methods: A total of 58 patients with progressive stroke caused by large intracranial vascular occlusion exceeding the time window of 24 hours treated in the stroke center of our hospital for three years were retrospectively analyzed . According to the applied therapy, 58 patients were divided into the endovascular (n = 19) and drug (n = 39) therapy groups. Then, modified Rankin scale (mRS) scores, symptomatic intracranial hemorrhage rates, mortality rates and adverse events were assessed in both groups within 90 days. Results: The 90-day good prognosis rate was significantly higher in the endovascular therapy group compared with the drug group (68.4% VS 38.5%, odds ratio [OR] = 0.29; 95% confidence interval [CI], 0.09-0.92; P = 0.032). The 90-day NIHSS scores were lower in the endovascular therapy group compared with the drug group (3.3 ± 2.6 VS 5.2 ± 3.0, OR = −1.89; 95%CI, −3.50 to −0.27; P = 0.023). Meanwhile, the proportion of patients with a Barthel index of 90-100 was significantly higher in the endovascular therapy group compared with the drug group (53.0% VS 25.6%, OR = 0.31; 95%CI, 0.10-0.98; P = 0.042). Finally, both groups showed similar rates of adverse events. Conclusion:In patients with progressive stroke caused by large intracranial vascular occlusion exceeding 24 hours, endovascular therapy probably results in improved efficacy at 90 days compared with drug therapy, without increasing the rates of adverse effects.

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Neurologic Functional Outcomes of Decompressive Hemicraniectomy Versus Conventional Treatment for Malignant Middle Cerebral Artery Infarction: A Systematic Review and Meta-Analysis

Cited by 19 publications

References 54 publications

European Stroke Organisation (ESO) guidelines on the management of space-occupying brain infarction

European Stroke Organisation (ESO) guidelines on the management of space-occupying brain infarction

Decompressive craniotomy for malignant middle cerebral artery infarction: The quest for an African perspective

Safety and efficacy of intravascular therapy in patients with progressive stroke caused by intracranial large vascular occlusion exceeding the time window of 24 hours

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