Decompressive Craniectomy for Malignant Ischemic Stroke: An Institutional Experience of 145 Cases in a Brazilian Medical Center

Severo, Luiz Carlos; Silva, Ana Cristina Veiga; Neto, Otávio da Cunha Ferreira; Neto, Joaquim Fechine de Alencar; Menezes, Marcelo Diniz de; Gemir, Júlia Lins; Lima, Luís Felipe Gonçalves de; Galvão, Maria Júlia Tabosa de Carvalho; Dias, Artêmio José Araruna; Sanchez, Luana Moury Fernandes; Lemos, Nilson Batista; Diniz, Andrey Maia Silva; Almeida, Nivaldo S.; Valênça, Marcelo Moraes; Filho, Hildo Rocha Cirne de Azevedo

doi:10.1016/j.wneu.2022.02.061

Cited by 3 publications

(11 citation statements)

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“…Comparatively, as indicated by data from the retrospective study by Bem Junior (2021) the surgical approach with a time between 12 and 24 h was essential for a more favorable outcome ( 10 ). 17% of patients have operated within 12 h of symptom onset and >70% of patients had a relatively favorable outcome (mRS 2 and 3) at 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…This is a comparative analysis of results obtained from a retrospective study of patients undergoing decompressive craniectomy to control intracranial hypertension secondary to malignant ischemic stroke, developed at Hospital da Restauração (HR), between March 2010 and March 2018 by Bem Junior et al and secondary data was taken from four randomized clinical trials, published on the European continent between 2006 and 2011 ( 10 ). The main objective of this research is to compare the results of Bem Junior et al ( 10 ) and four randomized clinical trials since these trials suggest that the best time to perform decompressive craniectomy is between 12 and 24 h, and the results from previous studies indicate that the earlier approach can achieve more favorable outcomes ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

“…Data from the study by Bem Junior et al was collected from the medical records of the Neurosurgery service of Hospital da Restauração (HR), through a semi-structured collection instrument, which evaluated the following variables: age, sex, comorbidities, time from onset of symptoms to arrival at the hospital, time from symptom onset to neurosurgical procedure, laterality of the ischemic event, preoperative Glasgow Coma Scale (GCS), surgery time, intraoperative complications, postoperative complications, length of hospital stay and clinical/functional status after the procedure, evaluated by the modified Rankin Scale and Glasgow Outcome Scale ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

“…The analysis and comparison performed in this article were based on the interpretation of data available in the four clinical trials and the retrospective study developed by the group of Bem Junior et al ( 10 ). The variables analyzed and compared were: the age of patients, time for indication and performance of decompressive craniectomy and clinical outcome, using the modified Ranking Scale (mRS) for the latter.…”

Section: Methodsmentioning

confidence: 99%

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Decompressive craniectomy: Comparative analysis between surgical time and better prognosis

Severo

Silva

Menezes³

et al. 2022

Front. Neurol.

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BackgroundMalignant ischemic stroke is characterized by the involvement of 2/3 of the area of the middle cerebral artery, associated with cerebral edema, intracranial hypertension (ICH) and cerebral herniation, generating high morbidity and mortality. Over the years, several therapies have been studied in an attempt to reverse or reduce the damage caused by this vascular disorder, including decompressive craniectomy (DC), a surgical technique reserved for cases that evolve with refractory ICH.MethodsThis study seeks to perform a comparative analysis on the effectiveness of decompressive craniectomy using four randomized clinical trials and the results found in the retrospective study conducted in a neurosurgical reference center between 2010 and 2018.ResultsThe total sample consisted of 263 patients, among which 118 were randomized and 145 were part of the retrospective study. The outcome was analyzed based on the modified Rankin Scale (mRS) for 6 and 12 months. The mean time to perform the DC was 28.4 h in the randomized trials, with the late approach (> 24 h) associated with unfavorable outcomes (mRS between 4 and 6).ConclusionCompared to the aforementioned studies, the study by Bem Junior et al. shows that a surgical approach in < 12 h had a better outcome, with 70% of the patients treated early classified as mRS 2 and 3 at the end of 12 months (1). Decompressive craniectomy is currently the most effective measure to control refractory ICH in cases of malignant ischemic stroke, and the most appropriate approach before surgery is essential for a better prognosis for patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Decompressive craniectomy: Comparative analysis between surgical time and better prognosis

Severo

Silva

Menezes³

et al. 2022

Front. Neurol.

Self Cite

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“…The current opinion is that once brain herniation is detected by imaging, DC can be performed as soon as possible without waiting for neurological deterioration ( 11 ). A Brazilian study showed that early DC could significantly improve the prognosis of AIS patients ( 12 ). Bruno Askiel et al ( 13 ) proposed that patient age and midline shift after DC could predict neurological outcomes in post-DC patients.…”

Section: Introductionmentioning

confidence: 99%

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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Decompressive Craniectomy in Patients with Malignant Stroke with Additional Vascular Territory

Sampaio,

Fogaroli,

Botta

et al. 2024

World Neurosurgery

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Decompressive Craniectomy for Malignant Ischemic Stroke: An Institutional Experience of 145 Cases in a Brazilian Medical Center

Cited by 3 publications

References 18 publications

Decompressive craniectomy: Comparative analysis between surgical time and better prognosis

Decompressive craniectomy: Comparative analysis between surgical time and better prognosis

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

Decompressive Craniectomy in Patients with Malignant Stroke with Additional Vascular Territory

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