Decompressive Hemicraniectomy in a South American Population – Morbidity and Outcomes Analysis

Abstract

BackgroundMalignant cerebral artery strokes have a poor prognosis, with nearly 80% of mortality in some series despite intensive care. After a large randomized trial, decompressive hemicraniectomy has been performed more often in stroke patients. Here, we describe patients in a tertiary teaching hospital in Brazil, emphasizing the impact of age on outcomes.MethodsA retrospective cohort of patients, with malignant strokes which received a decompressive hemicraniectomy, from paper and electronic medical records, from January 2010 to December 2013 was divided into two groups according to age.ResultsThe final analysis included 60 patients. The overall mortality was higher among patients older than 60 yrs (67% vs. 41%; p = 0.039), whose group also had a worse outcome (76% with mRS 5 or 6) at 90 days (OR 3.91 CI95% 1.30–11.74), whereas only 24% had mRS of 0–4 (p = 0.015). All patients who presented with sepsis died (p = 0.003). The incidence of pulmonary infection was very high in the elderly group (76%) with significant intergroup differences (p = 0.027, OR 8.32 CI95% 0.70–98.48).ConclusionsOlder patients present more commonly with infections, more disabilities and a higher mortality, highlighting very poor results in elderly population. These results should be proved with a South American trial, and if confirmed, it can impact on future decisions regarding decompressive craniectomy for acute ischemic stroke in our region.

Outcomes of decompressive craniectomy for malignant middle cerebral artery stroke in an academic hospital in Brazil

“…The mean age was 54.6 AE 11.6 years and 64.2% were men. At admission, the median NIHSS was 20 (16)(17)(18)(19)(20)(21)(22)(23)(24) and the median GCS was 12 (10)(11)(12)(13)(14). The right hemisphere was the affected in most cases (60.4%).…”

“…9 There are limited data about DC and stroke in middleincome countries. In the only study from Brazil that 22 In China, Chen et al described a population of 60 patients, with a 27% mortality rate at 1-year. 23 In a cohort of 31 patients with MMCAI treated with DC, 39% were dead after 1year and 52% had mRS 4.…”

“…Objetivo Avaliar os desfechos dos pacientes com IMACM tratados com craniectomia descompressiva em um centro acadêmico terciário de AVC no Brasil. (16)(17)(18)(19)(20)(21)(22)(23)(24). A mortalidade hospitalar foi 30,2%.…”

The Role of Decompressive Craniectomy in Limited Resource Environments

“…A study from Brazil (40) presented a cohort of 60 patients with malignant middle cerebral artery (MCA) infarction who underwent unilateral DC. They showed that mortality was higher (67%) in patients > 60 years, while only 44% of the patients from the younger group (<60 years) had mRS 5–6 at 90 days follow-up.…”

Application of Stepwise Small Dural Window and External Intraventricular Drainage for Craniectomy in Patients with Severe Brain Injury

“…In recent years, although the great progress has been made in clinical diagnosis and treatment and related basic research to traumatic brain injury, the mortality and morbidity of it still remain the highest (1). And decompressive craniectomy (DC) is still the main and effective treatment for patients with acute severe craniocerebral injury as it is easy to carry out (2). DC is a surgical procedure in which part of the skull is removed to allow the brain to swell without being squeezed.…”