Decompressive craniectomy in malignant middle cerebral artery infarct: An institutional experience

Bansal, Hanish; Chaudhary, A.K.; Singh, Ashutosh; Paul, Birinder S; Garg, Rajveer

doi:10.4103/1793-5482.161191

Cited by 15 publications

(22 citation statements)

References 5 publications

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“…12 Ross et al had correlated the GCS score with TBI patients and found that 80.5% had GCS score (13-15), 10.5% had GCS score (9)(10)(11)(12) and 9% had GCS score (3-7), 11 which was complementary to the study. Where we concluded 48% had GCS score (13-15), 17% had GCS score (9)(10)(11)(12) and 34% had GCS score (3)(4)(5)(6)(7). Blenow et al disclosed information on FOUR scale score with TBI patients and found 62.86% had score (13-15), 10.67% had score (9)(10)(11)(12) and 26.47% had score (<8) which correlated the study proved that 55% had score (13-16), 14% had (9-12) and 31% had score (<8).…”

Section: Discussionmentioning

confidence: 89%

“…11 Study proved that the current distribution of severe, moderate and mild TBI as 29%, 4% and 67% respectively 11 which was a support to our study, where we have current distribution of severe, moderate and mild as 30%, 2%, 48% respectively. Subjects enrolled in the study were 68% of males and 32% of females which matched the criteria of the study done by Hanish et al 12 who reported 77.1% of males and 22.9% of females. 12 Ross et al had correlated the GCS score with TBI patients and found that 80.5% had GCS score (13-15), 10.5% had GCS score (9)(10)(11)(12) and 9% had GCS score (3-7), 11 which was complementary to the study.…”

Section: Discussionmentioning

confidence: 99%

“…Subjects enrolled in the study were 68% of males and 32% of females which matched the criteria of the study done by Hanish et al 12 who reported 77.1% of males and 22.9% of females. 12 Ross et al had correlated the GCS score with TBI patients and found that 80.5% had GCS score (13-15), 10.5% had GCS score (9)(10)(11)(12) and 9% had GCS score (3-7), 11 which was complementary to the study. Where we concluded 48% had GCS score (13-15), 17% had GCS score (9)(10)(11)(12) and 34% had GCS score (3)(4)(5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the Outcomes of Surgical Versus Conservative Treatments in Head Injury: A Comparative Observational Study Using Different Scales

Sunny¹,

Vajjapally²,

Bandaru³

et al. 2020

IJOPP

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Background: This study is to evaluate the outcomes of surgical versus conservative treatment in head injury by using different scales to rate the quality of life in both the treatments. Aim: To evaluate the outcomes of surgical versus conservative treatment in Head injury. Methods: A prospective, comparative observational study was conducted in Neurosurgery department in a tertiary care teaching hospital for a period of 6 months. All the patients with head injury were included in the study and reviewed.Among the subjects two groups are made in which one group includes the subjects who are treated with conservative treatment and the other group who have undergone surgical treatment among these two groups GCS scale, four score scale and dementia rating scale are assessed and both the treatments are compared. Results: Patients with head injury between age groups of 20 to 70 years were recruited for this study. The patients recovery analysis according to GCS for conservative (93.06%) and surgical (50.40%), FSS for conservative (90%) and surgical (56.75%), DRS for conservative (100%) and surgical (50.04%). Conclusion: Based on the severity it is decided whether conservative or surgical treatment is given to the patient, but primary choice of treatment should be conservative treatment for patients with less severity as patients under conservative treatment had better recovery and memory compared to that of patients under surgical treatment.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating the Outcomes of Surgical Versus Conservative Treatments in Head Injury: A Comparative Observational Study Using Different Scales

Sunny¹,

Vajjapally²,

Bandaru³

et al. 2020

IJOPP

View full text Add to dashboard Cite

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“…These results were supporting several published results, as well as the three main European trials investigating malignant MCA infarcts. The study published by Bansal et al demonstrated mean mRS 3.33 at discharge [2], and the study published by Raffiq MA showed good functional outcome based on mRS in 48.9% of patients at 3 months and in 64.4% of patients at 6 months [11]. Also the pooled analysis of the three European trials showed 43% of cases had favorable functional outcome and 29% mortality rate [9,6,12].…”

Section: Discussionmentioning

confidence: 91%

“…Just removal of the bone flap was proven to reduce ICP by 15%; further reduction, up to 70%, occurs after opening the dura. Elevation of a 12-cm-diameter bone flap will add 86-ml additional volume to the skull [2].…”

Section: Discussionmentioning

confidence: 99%

Decompressive craniectomy in malignant middle cerebral artery infarctions: outcome of 25 cases

Refaat

Abdallah

2018

Egypt J Neurosurg

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Background: Large space-occupying middle cerebral artery (MCA) infarctions with signs of elevated intracranial pressure and brain herniation have overall mortality rates of 80%. Several studies have suggested that decompressive surgery reduces mortality and improves outcome of these patients. Aim: The aim of this study was to evaluate the clinical and radiological outcome of decompressive craniectomy in the setting of malignant MCA infarctions. Patients and method: This is a prospective study conducted on patients presenting with manifestations of malignant MCA infarction. All cases were operated upon by decompressive craniectomy and duroplasty within 6 h of presentation or deterioration in Glasgow Coma Scale (GCS). Functional outcome was assessed in terms of mortality and modified Rankin Scale (mRS) for neurologic disability. Radiological outcome was assessed by comparing the midline shift in the preoperative CT and 24 to 96 h postoperatively. Results: Twenty-five patients were included in this study. The mean age was 64.4 years. The mean preoperative GCS score was 8.14. The mean preoperative midline shift was 7.9 mm. All cases showed radiological improvement in the early follow-up period. Good functional outcome based on mRS was achieved in 64% and poor outcome in 36% of cases. The overall mortality in this study was 28%. Conclusion: Early decompressive hemicraniectomy had a proven role in reduction of mortality and improving functional outcome in cases with malignant MCA infarction. Among other factors, timing of surgery and the preoperative clinical condition were factors that affected the final outcome.

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Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques

Brown,

Gendreau,

Rahmani

et al. 2024

Neurosurg Rev

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Decompressive hemicraniectomy (DHC) is a critical procedure used to alleviate elevated intracranial pressure (ICP) in emergent situations. It is typically performed to create space for the swelling brain and to prevent dangerous and potentially fatal increases in ICP. DHC is indicated for pathologies ranging from MCA stroke to traumatic subarachnoid hemorrhage—essentially any cause of refractory brain swelling and elevated ICPs. Scalp incisions for opening and closing the soft tissues during DHC are crucial to achieve optimal outcomes by promoting proper wound healing and minimizing surgical site infections (SSIs). Though the reverse question mark (RQM) scalp incision has gained significant traction within neurosurgical practice, alternatives—including the retroauricular (RA) and Kempe incisions—have been proposed. As choice of technique can impact postoperative outcomes and complications, we sought to compare outcomes associated with different scalp incision techniques used during DHC. We queried three databases according to PRISMA guidelines in order to identify studies comparing outcomes between the RQM versus “alternative” scalp incision techniques for DHC. Our primary outcome of interest in the present study was postoperative wound infection rates according to scalp incision type. Secondary outcomes included estimated blood loss (EBL) and operative duration. We identified seven studies eligible for inclusion in the formal meta-analysis. The traditional RQM technique shortened operative times by 36.56 min, on average. Additionally, mean EBL was significantly lower when the RQM scalp incision was used. Postoperatively, there was no significant association between DHC incision type and mean intensive care unit (ICU) length of stay (LOS), nor was there a significant difference in predisposition to developing wound complications or infections between the RQM and retroauricular/Kempe incision cohorts. Superficial temporal artery (STA) preservation and reoperation rates were collected but could not be analyzed due to insufficient number of studies reporting these outcomes. Our meta-analysis suggests that there is no significant difference between scalp incision techniques as they relate to surgical site infection and wound complications. At present, it appears that outcomes following DHC can be improved by ensuring that the bone flap is large enough to enable sufficient cerebral expansion and decompression of the temporal lobe, the latter of which is of particular importance. Although previous studies have suggested that there are several advantages to performing alternative scalp incision techniques during DHC, the present study (which is to our knowledge the first to meta-analyze the literature on outcomes in DHC by scalp incision type) does not support these findings. As such, further investigations in the form of prospective trials with high statistical power are merited.

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Decompressive craniectomy in malignant middle cerebral artery infarct: An institutional experience

Cited by 15 publications

References 5 publications

Evaluating the Outcomes of Surgical Versus Conservative Treatments in Head Injury: A Comparative Observational Study Using Different Scales

Evaluating the Outcomes of Surgical Versus Conservative Treatments in Head Injury: A Comparative Observational Study Using Different Scales

Decompressive craniectomy in malignant middle cerebral artery infarctions: outcome of 25 cases

Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques

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