Decompressive craniectomy in malignant middle cerebral artery infarction – monoinstitutional retrospective analysis of a set of 33 patients

Czech version

Authors: K. Pištěk; M. Sameš
Authors‘ workplace: Neurochirurgická klinika FZS UJEP, a Krajské zdravotní a. s. – Masarykovy, nemocnice v Ústí nad Labem, o. z.
Published in: Cesk Slov Neurol N 2020; 83/116(5): 559-562
Category: Short Communication
doi: https://doi.org/10.14735/amcsnn2020559

Overview

Aim: Decompressive craniectomy is a method of choice in the treatment of malignant middle cerebral artery infarction. Based on the conclusions of the three European prospective trials DECIMAL, DESTINY and HAMLET and their pooled analysis, we performed a retrospective analysis for years 2014–2018 at our department to assess the clinical outcome of patients who underwent decompressive craniectomy for malignant middle cerebral artery infarction. Patients and methods: The set consisted of 33 patients.

Results: 22 operated patients died as a result of the disease, three patients were grade 4 and four patients grade 3 on the modified Rankin Scale. Four patients had to be excluded from the cohort. We monitored parameters such as the patient’s age at time of stroke, the time that had elapsed since the clinical manifestation and since determination of diagnosis according to CT to the start of surgery and midline shift on CT. We performed a statistical analysis of the baseline data, but these were not entirely beneficial for a probably small group of patients.

Conclusion: In general, in line with the findings of European studies, the patient’s age at stroke onset (below 60 years) and the time elapsed from the clinical manifestation and from graphic signs of ischemia to the start of decompressive craniectomy (less than 48 h) are essential positive prognostic factors.

Keywords:

indications – decompressive craniectomy – malignant middle cerebral artery infarction – retrospective analysis

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