Predicting Functional Outcome After Decompressive Craniectomy for Malignant Hemispheric Infarction: Clinical and Novel Imaging Factors

Bruno, Askiel; Paletta, Nina; Verma, Uttam; Grabowska, Monika E.; Haughey, Heather M.; Batchala, Prem P.; Abay, Solomon; Donahue, Joseph; Vender, John R.; Sethuraman, Sankara; Nichols, Fenwick T.

doi:10.1016/j.wneu.2021.12.027

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…Different studies addressed the prognostic role of pre-DC imaging findings [11][12][13][14][15][16]. consistently showed that increased post-DC midline shift is associated with worse functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Radiological and blood markers predicting long term neurological outcome following decompressive craniectomy for malignant ischemic stroke: a preliminary single center study

Paracino,

De Domenico,

DI Rienzo

et al. 2024

J Neurol Surg A Cent Eur Neurosurg

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Objective. Malignant ischemic stroke (MIS) is defined by progressive cerebral edema leading to intracranial pressure, compression of neural structurs and, eventually, death. Decompressive craniectomy (DC) has been advocated as a lifesaving procedure in the management of patients with MIS. This study aims to identify pre- and postoperative predictive variables of neurological outcomes in patients undergoing DC for MIS. Methods. We conducted a retrospective study of patients undergoing decompressive hemi-craniectomy in a single center from April 2016 to April 2020. Preoperative work-up included baseline clinical status, laboratory data, and brain CT. The primary outcome was the 6-months modified ranking score (mRS). The secondary outcome was the 30-day mortality. Results. During data capture a total of 58 patients fulfilled the criteria for MIS, of which 22 underwent DC for medically refractory increased ICP and were included in the present analysis. The overall median age was 58.5 years old. An immediate (24hr) postoperative GOSE score >= 5 was associated with good 6-month mRS (1-3)(p=0.004). Similarly, low postoperative neutrophils (p=0.002), low lymphocytes (p=0.004), decreased neutrophil to lymphocyte ratio (NLR)(p=0.02) and decreased platelet to lymphocytes ratio (PLR)(p=0.03) were associated with good neurological outcomes. Per-operative variables independently associated with worsened 6-month mRS were: increased age (OR 1.10, 95% CI 1.01-1.20, p=0.02), increased NIHSS score (OR 7.8, 95% CI 2.5-12.5, p=0.035), GCS < 8 at the time of neurosurgical referral (OR 21.63, 95% CI 1.42-328, p=0.02), and increased PTT time before surgery (OR 2.11, 95% CI 1.11-4, p=0.02). Decreased postoperative lymphocytes confirmed a protective role against worsened functional outcomes (OR 0.01, 95% CI 0.01-0.4, p=0.02). Decreased post-operative lymphocyte count was associated with showed a protective role against increased mRS (OR: 0.01, 95% CI: 0.01-0.4; p=0.02). The occurrence of hydrocephalus at postoperative CT scan was associated with 30-day mortality (p=0.005), while the persistence of postoperative compression of the ambient and crural cistern showed a trend towards significance (p=0.07). Conclusions This study reports that patients undergoing DC for MIS showing decreased postoperative blood inflammatory markers achieved better 6-month neurological outcomes than patients with increased inflammatory markers. Similarly, poor NIHSS, poor GCS, increased age, and larger PTT values at the time of surgery were independent predictors of poor outcomes. Moreover, the persistence of postoperative compression of basal cisterns and the occurrence of hydrocephalus is associated with 30-day mortality.

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Section: Discussionmentioning

confidence: 99%

“…The patients were classified into good (GCS 13-15), intermediate (9)(10)(11)(12)(13), or poor (<=8) admission status. A pre-operative head CT scan was performed in all included cases before DC.…”

Section: Management Definitions and End Pointsmentioning

confidence: 99%

Radiological and blood markers predicting long term neurological outcome following decompressive craniectomy for malignant ischemic stroke: a preliminary single center study

Paracino,

De Domenico,

DI Rienzo

et al. 2024

J Neurol Surg A Cent Eur Neurosurg

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“…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. Oliveira BDD et al ( 14 ) stated that ultrasound monitoring of the optic nerve sheath diameter can identify severe intracranial hypertension in patients with large vessel occlusion, and this parameter can be used as a predictive factor for DC.…”

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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Predicting Functional Outcome After Decompressive Craniectomy for Malignant Hemispheric Infarction: Clinical and Novel Imaging Factors

Cited by 2 publications

References 23 publications

Radiological and blood markers predicting long term neurological outcome following decompressive craniectomy for malignant ischemic stroke: a preliminary single center study

Radiological and blood markers predicting long term neurological outcome following decompressive craniectomy for malignant ischemic stroke: a preliminary single center study

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

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