Resolution of extra-axial collections after decompressive craniectomy for ischemic stroke

Ropper, Alexander E.; Nalbach, Stephen V.; Lin, Ning; Dunn, Ian F.; Gormley, William B.

doi:10.1016/j.jocn.2011.08.004

Cited by 12 publications

(6 citation statements)

References 13 publications

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“…Hydrocephalus was reported in 14.8 % (290/1966) of TBI patients [10, 11, 14, 24, 25, 27, 38, 39, 42, 50–53, 73, 83, 85, 94–104]. Interestingly, hydrocephalus was reported most frequently in ischemic stroke patients [30, 31, 56, 58, 59, 80, 87, 105] and hemorrhagic stroke patients [10, 88, 106, 107], at 25.5 % (93/364) and 21.1 % (46/218), respectively. In studies where authors did not stratify by indication [12, 64, 108–110], hydrocephalus was reported in 12.7 % (40/315) of patients.…”

Section: Resultsmentioning

confidence: 99%

“…Hygroma/effusion was reported in 27.4 % (723/2643) of patients with TBI [15, 19–21, 24, 25, 27, 29, 38, 39, 51, 52, 55, 65, 68, 77, 95–97, 99–104, 111, 112] and 12.5 % (42/336) of patients with malignant infarction [30, 59, 78, 105, 110, 113, 114] treated with DC. In a case series of DC for severe TBI in children, Hejazi et al [115] observed that 57.1 % (4/7) of patients developed hygroma.…”

Section: Resultsmentioning

confidence: 99%

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Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the boneflap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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“…[ 2 , 3 , 6 , 19 , 26 , 34 ] Hydrocephalus is reported prior to and following hemicraniectomy, and is associated with significant morbidity. [ 32 , 34 , 36 ] Syndrome of the trephined is another complication that has been described and arises from the loss of skull integrity from leaving the bone flap out. It is characterised by cognitive and neurological disturbance but normally improves following cranioplasty.…”

Section: Discussionmentioning

confidence: 99%

Strokectomy for malignant middle cerebral artery infarction: experience and meta-analysis of current evidence

et al. 2020

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Strokectomy means surgical excision of infarcted brain tissue post-stroke with preservation of skull integrity, distinguishing it from decompressive hemicraniectomy. Both can mitigate malignant middle cerebral artery (MCA) syndrome but evidence regarding strokectomy is sparse. Here, we report our data and meta-analysis of strokectomy compared to hemicraniectomy for malignant MCA infarction. All malignant MCA stroke cases requiring surgical intervention in a large tertiary centre (January 2012–December 2017, N = 24) were analysed for craniotomy diameter, complications, length of follow-up and outcome measured using the modified Rankin score (mRS). Good outcome was defined as mRS 0–3 at 12 months. In a meta-analysis, outcome from strokectomy (pooled from our cohort and published strokectomy studies) was compared with hemicraniectomy (our cohort pooled with published DECIMAL, DESTINY and HAMLET clinical trial data). In our series (N = 24, 12/12 F/M; mean age: 45.83 ± 8.91, range 29–63 years), 4 patients underwent strokectomy (SC) and 20 hemicraniectomy (HC). Among SC patients, craniotomy diameter was smaller, relative to HC patients (86 ± 13.10 mm, 120 ± 4.10 mm, respectively; p = 0.003), complications were less common (25%, 55%) and poor outcomes were less common (25%, 70%). In the pooled data (N = 41 SC, 71 HC), strokectomy tended towards good outcome more than hemicraniectomy (OR 2.2, 95% CI 0.99–4.7; p = 0.051). In conclusion, strokectomy may be non-inferior, lower risk and cost saving relative to hemicraniectomy sufficiently to be worthy of further investigation and maybe a randomised trial.

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“…First, the survey was advertised in the UK, and respondents are from the UK. There is inter- and intra-country variability in the use of helmets after decompressive hemicraniectomy (13) (14) (15). Different countries may use helmets post hemi-craniectomy to different extents.…”

Section: Discussionmentioning

confidence: 99%

Physiotherapist confidence level in mobilising stroke patients after decompressive hemicraniectomy: are helmets useful?

Budhdeo

Meek

Cosco

et al. 2019

Preprint

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IntroductionDecompressive hemicraniectomy is a lifesaving measure in malignant middle cerebral artery infarction; however, this leaves patients with a skull defect. There is variability of helmet use in this patient group across Britain. We aimed to examine whether (1) specialist physiotherapist were more confident mobilising a patient with hemiparesis and skull defect than a non-specialist physiotherapist (2) non-specialist and specialist physiotherapists would be more comfortable mobilising this patient with a helmet as opposed to without a helmet.MethodsWe carried out a cross-sectional online survey of specialist physiotherapists and non-specialist physiotherapists in Britain. Recruitment was through mailing lists. Physiotherapists were asked to rank their confidence level on a 5-point Likert scale of mobilising an example patient with and without a helmet. They were also asked about the number of additional therapists needed to safely mobilise the patient.Findings96 physiotherapists completed the survey; 44 were specialists and 52 were non-specialists. Specialist physiotherapists felt more comfortable mobilising patients (mean difference = 0.68, p < 0.001). Non-specialist physiotherapists felt significantly more comfortable mobilising patients with a helmet (mean difference = 0.96, p value < 0.001), as did specialist physiotherapists (mean difference = 0.68, p value < 0.001). There was no difference in confidence level arising from helmet use between the two groups (p = 0.72).ConclusionsUse of helmets may allow specialist and non-specialist physiotherapists to feel more comfortable when mobilising stroke patients post-decompressive hemicraniectomy. Consideration should be made by hospitals and health systems for the provision of helmets this patient group, to maximise functional gains.

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Resolution of extra-axial collections after decompressive craniectomy for ischemic stroke

Cited by 12 publications

References 13 publications

Complications Associated with Decompressive Craniectomy: A Systematic Review

Complications Associated with Decompressive Craniectomy: A Systematic Review

Strokectomy for malignant middle cerebral artery infarction: experience and meta-analysis of current evidence

Physiotherapist confidence level in mobilising stroke patients after decompressive hemicraniectomy: are helmets useful?

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