Related Experiment Videos
Decompressive craniectomy for hemispheric infarction: predictive factors for six month rehabilitation outcome
1Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. georgewong@surgery.cuhk.edu.hk
Insights
Decompressive craniectomy for hemispheric infarction does not guarantee better outcomes. Early surgery within 48 hours is not predictive of neurological recovery at six months post-stroke.
Area of Science:
- Neurosurgery
- Neurology
- Stroke Medicine
Background:
- Decompressive craniectomy can improve outcomes for select patients with hemispheric infarction.
- Optimal surgical timing and patient selection remain unclear.
Purpose of the Study:
- To identify factors predicting outcomes after decompressive craniectomy for ischemic stroke.
- To evaluate neurological outcomes at six months post-surgery.
Main Methods:
- Retrospective review of 21 patients undergoing decompressive craniectomy for hemispheric infarction.
- Inclusion of patients in active in-patient rehabilitation.
Main Results:
- 19% of patients achieved independent daily living at six months.
- Neither early surgery (24-48 hours) nor infarction side predicted six-month neurological outcome.
- Favorable outcomes at six months were preceded by clinical improvement at one month.
Conclusions:
- Early decompressive hemicraniectomy is not predictive of six-month neurological outcomes (Glasgow Outcome Scale).
Background:
Decompressive craniectomy after hemispheric infarction has been shown to reduce mortality and functional outcome in selected patients. However, the optimal timing for surgery and patient most likely to benefit from this procedures was not known. We aimed to determine possible factors predictive of outcome following decompressive craniectomy for ischemic infarction from review of oneurological outcome in our patients at six months.
Methods:
We retrospectively reviewed 21 patients who underwent decompressive craniectomy for hemispheric infarction over a three year period in a regional neurosurgical center in Hong Kong. All patients were recruited subsequently for active in-patient rehabilitation, when suitable.
Findings:
The median age was 53 and the male to female ration was 1:3. Four patients (19%) achieved independent activity of daily living at six months after rehabilitation. Neither early surgery, within 24-48 hours after admission, nor side of infarction correlated with six month neurological outcome. All four patients with favourable neurological outcome at six month demonstrated favourable clinical improvement even at one month.
Conclusions:
Early decompressive hemicraniectomy is not predictive of neurological outcome, determined by Glasgow outcome score, at six months (P = 1.00, NS).