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Published on: October 15, 2021
Outcome and prognostic factors of hemicraniectomy for space occupying cerebral infarction
1Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany. euhl@nc.med.uni-muenchen.de
Insights
Decompressive craniectomy outcomes are promising for younger patients with middle cerebral artery infarction. However, outcomes for older patients remain uncertain, necessitating further investigation.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Space-occupying middle cerebral artery (MCA) infarction is a severe neurological condition.
- Decompressive craniectomy is a surgical intervention aimed at reducing intracranial pressure and improving outcomes.
Purpose of the Study:
- To evaluate the long-term functional outcomes and survival rates of patients who underwent decompressive craniectomy for MCA infarction.
- To identify prognostic factors influencing survival and functional outcomes in this patient cohort.
Main Methods:
- A retrospective analysis of 188 patients from eight neurosurgical departments (1996-2001) who underwent decompressive craniectomy for MCA infarction.
- Kaplan-Meier survival analysis and multivariate logistic regression were used to assess mortality and functional outcomes (Glasgow Outcome Scale - GOS).
Main Results:
- Unadjusted 6-month mortality was 37.6%, with adjusted rates ranging from 20.0% to 59.7% based on risk factors.
- Age over 50 years and involvement of multiple vascular territories were significant predictors of reduced survival and unfavorable GOS scores.
- Younger patients (<50 years) demonstrated more favorable outcomes compared to older patients.
Conclusions:
- Decompressive craniectomy shows encouraging results for younger patients (<50 years) with MCA infarction.
- The efficacy of decompressive craniectomy in older patients (>50 years) warrants further evaluation through prospective randomized trials.
Objective:
To determine long term functional outcome and length of survival of patients undergoing decompressive craniectomy for space occupying infarction of the middle cerebral artery (MCA), and to identify risk factors associated with death and unfavourable outcomes
Methods:
Databases of patients undergoing decompressive craniectomy for space occupying MCA infarction compiled at eight neurosurgical departments (1996-2001) were merged, and 188 patients were evaluated. Mortality was calculated by the Kaplan-Meier method. Clinical outcome was rated using the Glasgow outcome scale (GOS). The prognostic impact of patient related covariates on length of survival and the GOS was analysed multivariately.
Results:
The unadjusted 3, 6, and 12 month mortality rates were 7.9%, 37.6%, and 43.8%, respectively (median follow up, 26 weeks). In the "best" multivariate model, age >50 years (p<0.02) and the involvement of two or more additional vascular territories (p<0.01) had an unfavourable impact on length of survival. The adjusted six month mortality was as low as 20.0% (no risk factor) and as high as 59.7% (two risk factors). A GOS score of
Conclusions:
Results of surgical treatment in patients <50 years of age undergoing decompressive craniectomy are encouraging. The effectiveness of decompressive craniectomy for patients >50 years remains questionable and should be analysed in the framework of a prospective randomised study.
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