Outcomes After Decompressive Craniectomy for Ischemic Stroke: A Volumetric Analysis

Parish, Jonathan; Asher, Anthony M.; Pfortmiller, Deborah; Clemente, Jonathan D.; Stetler, William R.; Bernard, J

doi:10.1016/j.wneu.2020.10.036

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…Similarly, the results of Vahedi's pooled analysis of three European trials comparing the clinical outcome of patients operated up to and after 24 hours from the beginning of symptoms did not show any difference in functional outcome (1). On the other hand, recent studies (9,10) reported that DHC performed even later than48 hours after stroke did not significantly increase the risk of an unfavorable outcome. Looking at our data and the literature, we cannot make any clear evidence-based recommendation at this time as to the timing of surgery.…”

Section: Discussionmentioning

confidence: 88%

“…Optimal selection of candidates for DHC after MHI who would benefit from surgery still remains a subject of interest. The associations of many patientspecific factors with the postoperative outcome has been studied recently (4,(6)(7)(8)(9)(10). There are also several computed algorithms designed to improve the decision-making process of indication for DHC (11).…”

Section: Introductionmentioning

confidence: 99%

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Estimation of prognosis in patients after decompressive craniectomy after malignant hemispheric infarction: multifactorial scoring scale

CHRENKO,

TRNOVEC,

HANKO

et al. 2024

BLL

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BACKGROUND: Patient's age is considered to be one of the most relevant factors in selecting surgical candidates for decompressive hemicraniectomy after malignant hemispheric infarction. However, questions about surgical indication in older patients, patients with consciousness disorder or patients with large infarctions remain unanswered. OBJECTIVE: Our aim was to design a multifactorial scoring scale based on a combination of patient-specific factors in order to optimize the assessment of prognosis in patients after hemicraniectomy malignant strokes. METHODS: In this prospective observational study with a one-year follow-up, we assessed clinical and imaging data of patients who underwent decompressive hemicraniectomy due to malignant brain infarction. Barthel index was used as a single outcome measure to distinguish favorable vs. unfavorable outcomes. Associations between multiple variables and clinical outcome were assessed. Subsequently, a design of a predictive scoring system was proposed. RESULTS: Age of the patient, preoperative level of consciousness, midline shift, and volume of infarction showed a significant association with postoperative Barthel index. According to the identified factors, a multifactorial prognostic scoring system was introduced, aimed to distinguish between favorable and unfavorable outcomes. Using ROC analysis, it has achieved an AUC of 0.74 (95%CI 0.58-0.89, p=0.01) CONCLUSIONS: Prediction of postoperative outcome should be based on multiple variables. Our scale, based on the clinical and imaging data, can be used during decision-making to estimate potential benefit of decompressive craniectomy in patients after malignant brain infarction (Tab. 5, Fig. 1, Ref. 32).

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Estimation of prognosis in patients after decompressive craniectomy after malignant hemispheric infarction: multifactorial scoring scale

CHRENKO,

TRNOVEC,

HANKO

et al. 2024

BLL

View full text Add to dashboard Cite

show abstract

“…A positive association has been reported in 3 retrospective and monocentric studies analyzing infarct volumes before surgery, after surgery, or at both times with either CT or MRI and complete outcome assessment at 3, 6, or 12 months. 8,9,25 Infarct volume thresholds for the prediction of favorable outcome were substantially higher compared to our present study: one study using CT in 34 patients before surgery reported a threshold of 300 mL with 100% sensitivity and 65% specificity after 6 months 9 ; the second study in 52 patients using MRI before surgery reported 280 mL with 100% sensitivity and 29% specificity after 3 months 25 ; and the largest of these studies using CT in 96 patients after surgery reported 270 mL with 81% sensitivity and 74% specificity after 12 months. 8 What is most remarkable is that, despite these differences, clinical baseline data and rate of favorable outcome are quite similar among all studies, including the present analysis.…”

Section: Discussionmentioning

confidence: 99%

Association of Infarct Volume Before Hemicraniectomy and Outcome After Malignant Infarction

et al. 2021

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ObjectiveTo determine the impact of infarct volume before hemicraniectomy in malignant middle cerebral artery infarction (MMI) as an independent predictor for patient selection and outcome prediction, we retrospectively analyzed data of 140 patients from a prospective multi-center study.MethodsPatients from the DESTINY-Registry that underwent hemicraniectomy after ischemic infarction of >50% of the middle cerebral artery territory were included. Functional outcome according to the modified Rankin Scale (mRS) was assessed at 12 months. Unfavorable outcome was defined as mRS 4-6. Infarct size was quantified semi-automatically from computed tomography or magnetic resonance imaging before hemicraniectomy. Subgroup analyses in patients fulfilling inclusion criteria of randomized trials in younger patients (age≤60y) were predefined.ResultsAmong 140 patients with complete datasets (34% female, mean (SD) age 54 (11) years), 105 (75%) had an unfavorable outcome (mRS > 3). Mean (SD) infarct volume was 238 (63) ml. Multivariable logistic regression identified age (OR 1.08 per 1 year increase; 95%-CI 1.02-1.13; p=0.004), infarct size (OR 1.27 per 10ml increase; 95%-CI 1.12-1.44; p<0.001) and NIHSS (OR 1.10; 95%-CI 1.01-1.20; p=0.030) before hemicraniectomy as independent predictors for unfavorable outcome. Findings were reproduced in patients fulfilling inclusion criteria of randomized trials in younger patients. Infarct volume thresholds for prediction of unfavorable outcome with high specificity (94% in overall cohort and 92% in younger patients) were more than 258 ml before hemicraniectomy.ConclusionOutcome in MMI strongly depends on age and infarct size before hemicraniectomy. Standardized volumetry may be helpful in the process of decision making concerning hemicraniectomy.

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Clinical cases in neurovascular diseases and traumatic brain injury

Konstantopoulos

Giakoumettis

2023

Neuroimaging in Neurogenic Communication Disorders

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Outcomes After Decompressive Craniectomy for Ischemic Stroke: A Volumetric Analysis

Cited by 5 publications

References 27 publications

Estimation of prognosis in patients after decompressive craniectomy after malignant hemispheric infarction: multifactorial scoring scale

Estimation of prognosis in patients after decompressive craniectomy after malignant hemispheric infarction: multifactorial scoring scale

Association of Infarct Volume Before Hemicraniectomy and Outcome After Malignant Infarction

Clinical cases in neurovascular diseases and traumatic brain injury

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