Is decompressive craniectomy for acute cerebral infarction of any benefit?

Koh, Mariko Siyue; Goh, Keith Y.C.; Tung, M. Y. Y.; Chan, Colin

doi:10.1016/s0090-3019(00)00163-4

Cited by 94 publications

(51 citation statements)

References 22 publications

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“…In several studies, age appeared as a negative predicting factor for favourable outcome. Several authors concluded that the mean age of the group with unfavourable outcome was 56.6 years [6,9,11,12]. Our study did not support this data.…”

Section: Discussioncontrasting

confidence: 96%

Decompressive Craniectomy for Intractable Intracranial Hypertension

Bakar¹

2012

Ann Clin Anal Med

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Section: Discussioncontrasting

confidence: 96%

Decompressive Craniectomy for Intractable Intracranial Hypertension

Bakar¹

2012

Ann Clin Anal Med

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“…There is no reported definite documentation in the current literature regarding the results of DS for such patients, except case reports including the patients with head injury or CVA. [21][22][23][24] Nevertheless, the question may be raised whether the lack of demonstrable efficacy of DS in our patient study group was due to the small sample size.…”

Section: Discussion Causes Of Pupillary Dilation In Patients Withmentioning

confidence: 99%

Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

Göksu

Uçar²,

Akyuz³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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AMAÇAğır travmatik beyin yaralanmalı (ATBY) ve bilateral reaktif olmayan pupil dilatasyonu (BRPD) olup, dekompresif cerrahi (DC) uygulanmış hastalarda Glasgow koma skalası (GKS), kafa içi basınç (KİB), serebral perfüzyon basın-cı (SPP) değişiklikleri ve uzun dönem klinik sonuçları değerlendirildi. GEREÇ VE YÖNTEMÇalışma gurubu, bölümümüzde ATBY nedeniyle DC uygulanan 147 hasta içerisinden BRPD'li 28 hastayı (11 kadın, 17 erkek) içerdi. BULGULAROrtalama GKS skoru, başvuruda 4,96±1,20, ameliyat ön-cesi dönemde 4 idi. Ölen hastalarda, DC sonrası ortalama KİB değerleri hayatta kalanlara göre anlamlı ölçüde yük-sekti (p<0,05). Ayrıca, DC sonrası KİB azalması, yaşayan hastalarda yine anlamlı olarak yüksekti (p<0,05). Tümden mortalite oranı %61,02 bulundu. Başvuruda ikinin üzeri GKS motor skoru anlamlı olarak düşük mortalite ile ilişki-li idi (p<0,05). Yaşayan 4 hasta taburcu sonrası birinci yıl-da (%14,28) işlevsel sonuç skoru (Glasgow sonuç skoru 4 ve 5) gösterdi. SONUÇATBY sonrası BRPD'li hastalarda sonuçlar her zaman ölümcül ya da olumsuz olmayabilir. Hızlı DC, özellikle başvuru GKS skoru 6, 7 olan hastalarda işlevsel sağkalım şansını artırabilir.Anahtar Sözcükler: Dekompresif cerrahi; travmatik beyin yaralanması; reaktif olmayan dilate pupil. BACKGROUNDWe investigated Glasgow Coma Scale (GCS) scores, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) changes, and long-term clinical outcomes in patients with severe traumatic brain injury (STBI) associated with bilateral non-reactive dilated pupils (BNDP) who underwent decompressive surgery (DS). METHODSThe study group consisted of 28 patients (11 females, 17 males) with BNDP from among 147 patients who underwent DS due to STBI in our department. RESULTSThe mean GCS score was 4.96±1.20 at admission and 4 preoperatively. Mean ICP in non-surviving patients after DS was higher (p<0.05). ICP decrease after DS was also higher in surviving patients than in non-surviving patients (p<0.05). The overall mortality rate was 61.02%. A GCS motor score >2 at admission was associated with lower mortality (p<0.05). Four of the surviving patients (14.28%) had a functional outcome (Glasgow Outcome Score: 4 and 5) at one year after hospital discharge. CONCLUSIONOutcome in patients with BNDP after STBI may not always be fatal or poor. Rapid DS may increase the chance of functional survival, especially in patients with admission GCS score of 6 or 7.

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“…17 If a cerebellar infarction produces a mass effect with signs of brainstem compression or herniation, a surgical decompressive procedure may be necessary in such patients. 24,25 Although reported strokes associated with marijuana use are few, marijuana use may represent a genuine risk factor for stroke, especially in the adolescent and particularly in the cerebellar circulation.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar Infarction in Adolescent Males Associated With Acute Marijuana Use

2004

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ABSTRACT.Objective. To demonstrate the clinical characteristics, radiologic findings, and neuropathological features of tetrahydrocannabinol-related posterior fossa ischemic stroke in adolescent patients.Design. A retrospective case and chart review of 3 cases encountered at a tertiary care institution over a span of 5 years.Setting. Inpatient and intensive care hospitalization units managing children and adolescents.Subjects. Male adolescent patients with ischemic cerebellar stroke after use of marijuana.Diagnostic Investigations. Computed tomography brain scans (3 subjects), magnetic resonance imaging brain study (1 subject), cerebral arteriography (1 subject), cerebellar biopsy (1 subject), and necropsy (2 subjects).Results. Three adolescent males had similar presentations of headache, fluctuating level of consciousness or lethargy, visual disturbance, and variable ataxia after self-administration of marijuana. They developed primary cerebellar infarctions within days after the exposure that could not be attributed to supratentorial herniation syndromes and only minimally involved brainstem structures.Conclusions. Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity. Pediatrics 2004;113:e365-e370. URL: http://www.pediatrics.org/cgi/content/full/113/4/e365; ischemic stroke, cerebral blood flow, marijuana, adolescent drug use.

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Is decompressive craniectomy for acute cerebral infarction of any benefit?

Cited by 94 publications

References 22 publications

Decompressive Craniectomy for Intractable Intracranial Hypertension

Decompressive Craniectomy for Intractable Intracranial Hypertension

Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

Cerebellar Infarction in Adolescent Males Associated With Acute Marijuana Use

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