Use of decompressive craniectomy in the treatment of hemispheric infarction

Fiorot, José Antonio; Silva, Gisele Sampaio; Cavalheiro, Sérgio; Massaro, Ayrton Roberto

doi:10.1590/s0004-282x2008000200012

Cited by 9 publications

(4 citation statements)

References 22 publications

(19 reference statements)

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“…The mean ictus-craniectomy interval for the patients of the present study was 39.7 The cardioembolic mechanism was the most prevalent in the present sample, found in 37.5% in the surgical group and 29.5% in the non-surgical group. The mean time between symptom onset and therapeutic decision among patients with hemispheric infarction in the study by Fiorot Junior et al 21 was 33 hours for craniectomized patients and 37 hours for non-craniectomized patients, whereas, in our study, 26.5 and 31 hours, respectively. In the DESTINY I study, these values were 24.4 ± 6.9 and 23.8 ± 7.8 hours, showing that the time for making decisions about the type of treatment in our hospital is similar to international data.…”

Section: Discussioncontrasting

confidence: 63%

“…Stratification of the modified Rankin Scale at the end of the 6-month follow-up in patients with ischemic stroke treated in a neurological emergency center. Fiorot Junior et al21 published that the mean age of patients was 59.1±18.0, whereas in our sample it was 50.0±10.9, with 46.6±13.2 in the DC group and 51.8±9.3 in the CT group. When risk factors were analyzed, 31.0% of the craniectomized patients and 22% of the non-craniectomized DECIMAL patients were hypertensive, whereas in the present study these figures were 62% and 64.7%, respectively, thus showing an unsatisfactory control of modifiable risk factors, such as hypertension.…”

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confidence: 71%

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Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke

Maia

Melo

Lima

et al. 2020

Arq. Neuro-Psiquiatr.

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ABSTRACT Background: Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. Objective: To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. Methods: Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. Results: A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). Conclusion: In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability.

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Section: Discussioncontrasting

confidence: 63%

contrasting

confidence: 71%

Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke

Maia

Melo

Lima

et al. 2020

Arq. Neuro-Psiquiatr.

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“…Several studies have reported that age should be considered an important factor in patients to be submitted to the surgical procedure 15,16,17 . The decision for patients over 60 years of age must be individualized: there is great controversy regarding this cut-off point, as some authors describe benefits beyond this age-group 12,15,18,19 , while others report unfavorable outcomes 6,7,8,9 .…”

Section: Discussionmentioning

confidence: 99%

Decompressive craniotomy for the treatment of malignant infarction of the middle cerebral artery: mortality and outcome

Bongiorni

Hockmuller

Klein

et al. 2017

Arq. Neuro-Psiquiatr.

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Objective: To assess, by Rankin scale, the functional disability of patients who had a malignant middle cerebral artery (MCA) ischemic stroke, who underwent decompressive craniotomy (DC) within the first 30 days. Methods: A cross-sectional study in a University hospital. Between June 2007 and December 2014, we retrospectively analyzed the records of all patients submitted to DC due to a malignant MCA infarction. The mortality rate was defined during the hospitalization period. The modified outcome Rankin score (mRS) was measured 30 days after the procedure, for stratification of the quality of life. Results: The DC mortality rate was 30% (95% CI 14.5 to 51.9) for the 20 patients reported. The mRS 30 days postoperatively was ≥ 4 [3.3 to 6] for all patients thereafter. Conclusion: DC is to be considered a real alternative for the treatment of patients with a malignant ischemic MCA infarction.Keywords: craniotomy; cerebral infarction; intracranial hypertension. RESUMOObjetivo: Avaliar a capacidade funcional de pacientes com acidente vascular cerebral isquêmico no território da artéria cerebral média (ACM) submetidos à craniotomia descompressiva (CD) no período de 30 dias pela escala de Rankin. Métodos: Estudo transversal em um hospital universitário. Entre junho de 2007 e dezembro de 2014, analisados retrospectivamente os registros de todos os pacientes submetidos a CD devido a enfarte maligno na ACM. A taxa de mortalidade foi definida durante o período de internação. O resultado da estratificação da qualidade de vida foi através da escala Rankin modificado (mRS) mensurado em 30 dias após o procedimento. Resultados: A taxa de mortalidade CD foi de 30% (IC 95% 14,5-51,9) para os 20 pacientes relatados. A mRS 30 dias de pós-operatório foi => 4 [3,3-6] para todos os pacientes. Conclusão: CD deve ser considerada uma alternativa real para o tratamento de pacientes com enfarte isquêmico no território da ACM.Palavras-chave: craniotomia; infarto cerebral; hipertensão intracraniana.A decompressive craniotomy (DC) has been a therapeutic option for an infarction of the middle cerebral artery (MCA) region. The goal of the surgical treatment is the reduction of the intracranial hypertension. The procedure is based on a fronto-parieto-temporal craniotomy, ipsilateral to the lesion, followed by plastic reconstruction of the dura mater, allowing immediate decompression of the brain 1,2,3,4,5 .Some complications, such as infection of the surgical area, temporal muscle hematoma with cerebral compression, intracerebral hemorrhage, or worsening of the neurological condition may follow DC 2,3,4 . In order to clearly define the indication for the surgical treatment and to decrease complications derived from DC in a university hospital in southern Brazil, a specific protocol for DC in the treatment of intracranial hypertension derived from ischemia of the MCA region has been implemented since 2007, in conjunction with the neurology department. Even though studies have demonstrated the efficacy of DC in patients presenting with ma...

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“…Decompressive craniectomy is the standard surgical treatment for malignant cerebral edema and brain herniation resulting from cerebral infarction, intracranial hemorrhage and severe traumatic brain injury6,16,18,20,24). After decompressive craniectomy, cranioplasty is also generally performed for the purpose of cosmetic recovery and to protect against the development of the syndrome of the trephined5).…”

Section: Introductionmentioning

confidence: 99%

Long-Term Incidence and Predicting Factors of Cranioplasty Infection after Decompressive Craniectomy

Jang

Han

et al. 2012

J Korean Neurosurg Soc

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ObjectiveThe predictors of cranioplasty infection after decompressive craniectomy have not yet been fully characterized. The objective of the current study was to compare the long-term incidences of surgical site infection according to the graft material and cranioplasty timing after craniectomy, and to determine the associated factors of cranioplasty infection.MethodsA retrospective cohort study was conducted to assess graft infection in patients who underwent cranioplasty after decompressive craniectomy between 2001 and 2011 at a single-center. From a total of 197 eligible patients, 131 patients undergoing 134 cranioplasties were assessed for event-free survival according to graft material and cranioplasty timing after craniectomy. Kaplan-Meier survival analysis and Cox regression methods were employed, with cranioplasty infection identified as the primary outcome. Secondary outcomes were also evaluated, including autogenous bone resorption, epidural hematoma, subdural hematoma and brain contusion.ResultsThe median follow-up duration was 454 days (range 10 to 3900 days), during which 14 (10.7%) patients suffered cranioplasty infection. There was no significant difference between the two groups for event-free survival rate for cranioplasty infection with either a cryopreserved or artificial bone graft (p=0.074). Intergroup differences according to cranioplasty time after craniectomy were also not observed (p=0.083). Poor neurologic outcome at cranioplasty significantly affected the development of cranioplasty infection (hazard ratio 5.203, 95% CI 1.075 to 25.193, p=0.04).ConclusionNeurologic status may influence cranioplasty infection after decompressive craniectomy. A further prospective study about predictors of cranioplasty infection including graft material and cranioplasty timing is necessary.

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Use of decompressive craniectomy in the treatment of hemispheric infarction

Cited by 9 publications

References 22 publications

Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke

Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke

Decompressive craniotomy for the treatment of malignant infarction of the middle cerebral artery: mortality and outcome

Long-Term Incidence and Predicting Factors of Cranioplasty Infection after Decompressive Craniectomy

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