Jarle Sundseth1, Antje Sundseth2,3, Eva Astrid Jacobsen4, Are Hugo Pripp5, Wilhelm Sorteberg6, Marianne Altmann3, Karl-Fredrik Lindegaard6,2, Jon Berg-Johnsen6,2, Bente Thommessen3. 1. Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway. jarle.sundseth@rikshospitalet.no. 2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. 3. Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway. 4. Department of Radiology, Oslo University Hospital Rikshospitalet, Oslo, Norway. 5. Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway. 6. Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway.
Abstract
BACKGROUND: Swollen middle cerebral artery infarction is a life-threatening disease and decompressive craniectomy is improving survival significantly. Despite decompressive surgery, however, many patients are not discharged from the hospital alive. We therefore wanted to search for predictors of early in-hospital death after craniectomy in swollen middle cerebral artery infarction. METHODS: All patients operated with decompressive craniectomy due to swollen middle cerebral artery infarction at the Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway, between May 1998 and October 2010, were included. Binary logistic regression analyses were performed and candidate variables were age, sex, time from stroke onset to decompressive craniectomy, NIHSS on admission, infarction territory, pineal gland displacement, reduction of pineal gland displacement after surgery, and craniectomy size. RESULTS: Fourteen out of 45 patients (31%) died during the primary hospitalization (range, 3-44 days). In the multivariate logistic regression model, middle cerebral artery infarction with additional anterior and/or posterior cerebral artery territory involvement was found as the only significant predictor of early in-hospital death (OR, 12.7; 95% CI, 0.01-0.77; p = 0.029). CONCLUSIONS: The present study identified additional territory infarction as a significant predictor of early in-hospital death. The relatively small sample size precludes firm conclusions.
BACKGROUND: Swollen middle cerebral artery infarction is a life-threatening disease and decompressive craniectomy is improving survival significantly. Despite decompressive surgery, however, many patients are not discharged from the hospital alive. We therefore wanted to search for predictors of early in-hospital death after craniectomy in swollen middle cerebral artery infarction. METHODS: All patients operated with decompressive craniectomy due to swollen middle cerebral artery infarction at the Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway, between May 1998 and October 2010, were included. Binary logistic regression analyses were performed and candidate variables were age, sex, time from stroke onset to decompressive craniectomy, NIHSS on admission, infarction territory, pineal gland displacement, reduction of pineal gland displacement after surgery, and craniectomy size. RESULTS: Fourteen out of 45 patients (31%) died during the primary hospitalization (range, 3-44 days). In the multivariate logistic regression model, middle cerebral artery infarction with additional anterior and/or posterior cerebral artery territory involvement was found as the only significant predictor of early in-hospital death (OR, 12.7; 95% CI, 0.01-0.77; p = 0.029). CONCLUSIONS: The present study identified additional territory infarction as a significant predictor of early in-hospital death. The relatively small sample size precludes firm conclusions.
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