Decompressive craniectomy in massive cerebral infarction

Abstract

Twenty one patients were submitted to decompressive craniectomy for massive cerebral infarct. Ten patients (47.6%) presented a good outcome at the 6 months evaluation, eight had a poor outcome (38%) and three died (14.2%). There was no outcome statistical difference between surgery before and after 24 hours of ictus, dominant and non-dominant stroke groups. Patients older than 60 years and those who had a Glasgow Coma Scale (GCS)<8 in the pre-surgical exam presented worst outcome at six months (p<0.05). Decompressive craniectomy for space-occupying large hemispheric infarction increases the probability of survival. Age lower than 60 years, GCS ≥8 at pre-surgical exam and decompressive craniectomy before signs of brain herniation represent the main factors related to a better outcome. Dominant hemispheric infarction does not represent exclusion criteria. Key words: cerebral infarction, decompressive hemicraniectomy, surgical decompression.Craniectomia descompressiva no infarto cerebral extenso RESUMO Vinte e um pacientes foram submetidos a craniectomia descompressiva para o tratamento de infarto cerebral extenso. Dez pacientes (47,6%) apresentaram boa evolução em avaliação após 6 meses, 8 apresentaram evolução desfavorável (38%) e 3 faleceram (14,2%). Durante o seguimento, não se evidenciou diferença estatística na evolução entre pacientes operados antes e após 24 horas do ictus, nem entre lesões envolvendo o hemisfério dominante versus não dominante. Pacientes com mais de 60 anos e aqueles com Escala de Coma de Glasgow (ECG)<8 na avaliação pré-operatória apresentaram pior evolução após 6 meses (p<0,05). A craniectomia descompressiva para infartos hemisféricos extensos aumentam a probabilidade de sobrevivência. Idade abaixo de 60 anos e ECG ≥8 no exame pré-operatório e craniectomia descompressiva antes de sinais de herniação cerebral representam os principais fatores relacionados a uma melhor evolução clínica. Infarto hemisférico envolvendo o hemisfério dominante não representa um critério de exclusão. Palavras-chave: infarto cerebral, hemicraniectomia descompressiva, descompressão cirúrgica.

Outcome Following Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction in Patients Older Than 70 Years Old

“…If a patient scores more than 20, it usually indicates a dense paralysis with impaired consciousness 2). NIHSS score ≥20 for left-sided infarctions, or ≥18 for right-sided infarctions may predict which patients will develop malignant edema and/or have a poor outcome 18). Lam et al16) concluded that a NIHSS score of > 22 is predictive of high mortality.…”

Outcome of decompressive craniectomy in comparison to nonsurgical treatment in patients with malignant MCA infarction

“…There is a lot of controversy in this issue. While some studies have shown that nearly half of patients had good outcome after surgery with GOS scores of 4 and 5 (Mattos et al 2010; Mori et al 2004), some others have reported that surgery could not achieve significant good results (Staykov & Gupta 2011; van der Worp & Kappelle 2011). This will increase the number of severely disabled patients, imposing significant pressure over the family and the whole society (Hofmeijer et al 2009; Schneck & Origitano 2006).…”

The Clinical Efficacy of Decompressive Craniectomy in Patients with an Internal Carotid Artery Territory Infarction

“…Steiger33) reported that of early neurologic findings, degree of motor paralysis and decreased mentality most importantly determine prognosis. Mattos et al22) found that a GCS score of ≤8 before surgery was associated with poorer prognosis, but Walz et al38) found that the surgical outcome of malignant MCA infarction was not related to initial NIHSS. In the present study, average preoperative NIHSS in group B was significantly lower than in group A ( p =0.019).…”