Decompressive Craniectomy for Hemispheric Infarction in a Low-Income Population

Garcia-Estrada, Everardo; Morales-Gómez, Jesús Alberto; Romero-González, Mariana; Martínez-Ortíz, Ricardo Gerardo; García-Hernández, Marco Antonio; Ramos-Delgado, César Alessandro; López-Hernández, Paúl André; Palacios-Ortiz, Isaac Jair; León, Ángel Raymundo Martínez-Ponce de

doi:10.1016/j.wneu.2021.09.013

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…Our nomogram model showed that older age and lower nomogram scores resulted in a lower probability of undergoing DC. Previous studies have reported that patients with cerebral infarction younger than 60 years old achieved a better outcome after DC ( 33 ). We suppose that age is negatively correlated with total brain volume, and elderly people usually have varying degrees of brain atrophy ( 34 ); therefore, brain edema after stroke is less likely to cause brain herniation in elderly patients, thereby reducing the probability of DC.…”

Section: Discussionmentioning

confidence: 97%

Systemic immune inflammatory index is an independent predictor for the requirement of decompressive craniectomy in large artery occlusion acute ischemic stroke patients after mechanical thrombectomy

Zhou

Zhu

et al. 2022

Front. Neurol.

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Background and purposeFollowing mechanical thrombectomy (MT), patients with large artery occlusive acute ischemic stroke (LAO-AIS) often have cerebral herniation due to its complications, resulting in poor prognosis. Decompressive craniectomy (DC) can markedly improve patient prognosis. This study aimed to verify the predictive value of clinical parameters such as the systemic immune-inflammatory index (SII) for DC in patients with LAO-AIS after MT.MethodsClinical data of a total of 173 patients with LAO-AIS treated with MT between January 2020 and January 2022 were retrospectively analyzed. Patients receiving DC were grouped into an experimental group or a control group (no DC). The patients were randomly divided into the training set (n = 126, 75%) and validation set (n = 43, 25%). Multivariate logistic regression was used to construct a nomogram predictive model.ResultsThe SII value in the experimental group (median: 2851.1×109/L) was significantly higher than that in the control group (median: 1898.6 × 109/L) (P = 0.019). Receiver operating characteristic (ROC) analyses showed that the best cutoff value of the SII was 2505.7 × 109/L with a sensitivity of 55%, a specificity of 75.8%, and an area under the curve (AUC) of 0.649. Multivariate logistic regression indicated that the SII was an independent predictor for performing DC in patients with LAO-AIS after MT (OR = 3.579, 95% CI = 1.360–9.422, P = 0.01). The AUC was 0.728 in the training set and 0.583 in the validation set. The average error of the calibration curve was 0.032 in the training set and 0.023 in the validation set. The average error was relatively small and consistent in the training set and validation set. The C-index of the nomogram was 0.804 suggesting good accuracy.ConclusionsThe SII at admission is an independent predictor for the requirement of DC in patients with LAO-AIS after MT. The SII-based nomogram helps doctors make decisions on whether DC is needed timely and rationally, and thereby may improve the prognosis of these patients.

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Section: Discussionmentioning

confidence: 97%

Systemic immune inflammatory index is an independent predictor for the requirement of decompressive craniectomy in large artery occlusion acute ischemic stroke patients after mechanical thrombectomy

Zhou

Zhu

et al. 2022

Front. Neurol.

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“…51 One study demonstrated 79% of caregivers would decide to perform DC again when surveyed at 1-year post-DC, providing empirical support for assuming informed consent for treatment in these situations. 52 In practice, surrogates often provide consent when patients have capacity, while patients with decreased capacity sometimes provide consent due to challenges assessing decision-making capacity. 53 Improved methods for assessing decision-making capacity are necessary.…”

Section: Decision-making Capacity and Informed Consentmentioning

confidence: 99%

Ethical Considerations in Surgical Decompression for Stroke

Shlobin

Clark

Campbell

et al. 2022

Stroke

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Stroke is a major cause of morbidity and mortality. Neurosurgical decompression is often considered for the treatment of malignant infarcts and intraparenchymal hemorrhages, but this treatment can be frought with ethical dilemmas. In this article, the authors outline the primary principles of bioethics and their application to stroke care, provide an overview of key ethical issues and special situations in the neurosurgical management of stroke, and highlight methods to improve ethical decision-making for patients with stroke. Understanding these ethical principles is essential for stroke care teams to deliver appropriate, timely, and ethical care to patients with stroke.

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Decompressive Hemicraniectomy in the Stroke Patient

Heck

2023

Critical Care Nursing Clinics of North America

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Decompressive Craniectomy for Hemispheric Infarction in a Low-Income Population

Cited by 3 publications

References 36 publications

Systemic immune inflammatory index is an independent predictor for the requirement of decompressive craniectomy in large artery occlusion acute ischemic stroke patients after mechanical thrombectomy

Systemic immune inflammatory index is an independent predictor for the requirement of decompressive craniectomy in large artery occlusion acute ischemic stroke patients after mechanical thrombectomy

Ethical Considerations in Surgical Decompression for Stroke

Decompressive Hemicraniectomy in the Stroke Patient

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