OBJECTIVE: Large or malignant middle cerebral artery infarction is associated with a high mortality rate. Hemicraniectomy reduces intracranial pressure and has been demonstrated to increase survival. Questions remain regarding selection of patients for surgery and functional outcomes. METHODS: We retrospectively reviewed the charts, operative reports, and images of patients who underwent hemicraniectomy for cerebral infarction at our institution between 1990 and 2002. Stroke volume and craniectomy area image analyses were performed with National Institutes of Health Image J software. Short-term outcome was measured with the Glasgow Outcome Scale. The requirement for second surgical decompression was also used as a measure of short-term outcome. Outcome 1 year after stroke was assessed with mailed self-report questionnaires to patients or providers with answers yielding information pertinent to the Barthel Index for physical disability, the Reintegration to Normal Living Index, and the Zung Depression Index. Univariate and multivariate logistic regression analyses were used to consider factors associated with outcome. RESULTS: Thirty-eight patients with large hemispheric infarcts (average volume, 407 cm3) were treated with hemicraniectomy during the study period. Thirty-two patients survived more than 1 year after surgery. Twenty patients responded to a questionnaire scoring late physical disability (Barthel Index), quality of life (Reintegration to Normal Living Index), and depression (Zung Depression Index). The average Barthel Index score was 67. Barthel Index score and ability to walk were strongly correlated with age but not time to surgery, volume of infarction, or craniectomy size. Patients exhibited moderate to severe decrements in quality of life and increased incidence of depression across all age groups. Reoperation, an indicator for early operative failure, was required in six patients. These patients were significantly younger and had significantly higher volumes of cerebral infarction. CONCLUSION: Hemicraniectomy is life-saving treatment for large middle cerebral artery infarction. Good functional outcomes can be obtained but are less likely in older patients. Younger patients with large-volume strokes may benefit from multiple decompressions, if necessary.
OBJECTIVE: Large or malignant middle cerebral artery infarction is associated with a high mortality rate. Hemicraniectomy reduces intracranial pressure and has been demonstrated to increase survival. Questions remain regarding selection of patients for surgery and functional outcomes. METHODS: We retrospectively reviewed the charts, operative reports, and images of patients who underwent hemicraniectomy for cerebral infarction at our institution between 1990 and 2002. Stroke volume and craniectomy area image analyses were performed with National Institutes of Health Image J software. Short-term outcome was measured with the Glasgow Outcome Scale. The requirement for second surgical decompression was also used as a measure of short-term outcome. Outcome 1 year after stroke was assessed with mailed self-report questionnaires to patients or providers with answers yielding information pertinent to the Barthel Index for physical disability, the Reintegration to Normal Living Index, and the Zung Depression Index. Univariate and multivariate logistic regression analyses were used to consider factors associated with outcome. RESULTS: Thirty-eight patients with large hemispheric infarcts (average volume, 407 cm3) were treated with hemicraniectomy during the study period. Thirty-two patients survived more than 1 year after surgery. Twenty patients responded to a questionnaire scoring late physical disability (Barthel Index), quality of life (Reintegration to Normal Living Index), and depression (Zung Depression Index). The average Barthel Index score was 67. Barthel Index score and ability to walk were strongly correlated with age but not time to surgery, volume of infarction, or craniectomy size. Patients exhibited moderate to severe decrements in quality of life and increased incidence of depression across all age groups. Reoperation, an indicator for early operative failure, was required in six patients. These patients were significantly younger and had significantly higher volumes of cerebral infarction. CONCLUSION:Hemicraniectomy is life-saving treatment for large middle cerebral artery infarction. Good functional outcomes can be obtained but are less likely in older patients. Younger patients with large-volume strokes may benefit from multiple decompressions, if necessary.
Authors: Michel T Torbey; Julian Bösel; Denise H Rhoney; Fred Rincon; Dimitre Staykov; Arun P Amar; Panayiotis N Varelas; Eric Jüttler; DaiWai Olson; Hagen B Huttner; Klaus Zweckberger; Kevin N Sheth; Christian Dohmen; Ansgar M Brambrink; Stephan A Mayer; Osama O Zaidat; Werner Hacke; Stefan Schwab Journal: Neurocrit Care Date: 2015-02 Impact factor: 3.210
Authors: Nils Hecht; Hermann Neugebauer; Ingo Fiss; Alexandra Pinczolits; Peter Vajkoczy; Eric Jüttler; Johannes Woitzik Journal: J Cereb Blood Flow Metab Date: 2017-06-30 Impact factor: 6.200
Authors: Hormuzdiyar H Dasenbrock; Faith C Robertson; M Ali Aziz-Sultan; Donovan Guittieres; Rose Du; Ian F Dunn; William B Gormley Journal: Neurocrit Care Date: 2016-12 Impact factor: 3.210
Authors: Michal Bar; Robert Mikulik; David Skoloudik; Daniel Czerny; Radim Lipina; Martin Sames; Milan Choc; Zdenek Novak; Marian Stary; Vladimir Benes; Martin Smrcka; Michal Filip; Denisa Vondrackova; Vladimir Chlouba; Petr Suchomel; Pavel Haninec; Richard Brzezny; Vilem Juran Journal: J Neurol Date: 2011-03-24 Impact factor: 4.849