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Improved hemodynamic parameters in middle cerebral artery infarction after decompressive craniectomy
Robson Luis Amorim1, Almir Ferreira de Andrade, Gabriel S Gattás
1From the Division of Neurosurgery (R.L.A., A.F.d.A., W.S.P., M.J.T., E.B.-S.-S.) and Department of Radiology (G.S.G., M.M.), University of São Paulo Medical School, São Paulo, Brazil.
Insights
Decompressive craniectomy improves cerebral hemodynamics in malignant middle cerebral artery infarction patients. Perfusion CT parameters after surgery can predict outcomes and identify patients who may not benefit from this intervention.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Decompressive craniectomy (DC) is established for malignant middle cerebral artery infarction.
- The impact of DC on cerebral hemodynamics remains unclear.
Purpose of the Study:
- To investigate hemodynamic changes post-DC in malignant middle cerebral artery infarction.
- To correlate these hemodynamic changes with patient outcomes.
Main Methods:
- Evaluated 27 patients with malignant middle cerebral artery infarction treated with DC.
- Assessed perfusion CT parameters (mean transit time, cerebral blood flow, cerebral blood volume) pre- and post-DC.
Main Results:
- A general trend of improved cerebral hemodynamics was observed after DC.
- Mean transit times and cerebral blood flow ratios correlated with mortality and functional outcomes.
- Patients undergoing surgery >48 hours post-stroke, with significant midline shift, or >55 years showed no hemodynamic improvement.
Conclusions:
- DC enhances cerebral hemodynamics in malignant middle cerebral artery infarction, with improvement linked to outcomes.
- Perfusion CT may serve as a prognostic tool for patients undergoing DC post-ischemic stroke.
Background And Purpose:
Decompressive craniectomy (DC) reduces mortality and improves functional outcome in patients with malignant middle cerebral artery infarction. However, little is known regarding the impact of DC on cerebral hemodynamics. Therefore, our goal was to study the hemodynamic changes that may occur in patients with malignant middle cerebral artery infarction after DC and to assess their relationship with outcomes.
Methods:
Twenty-seven patients with malignant middle cerebral artery infarction who were treated with DC were studied. The perfusion CT hemodynamic parameters, mean transit time, cerebral blood flow, and cerebral blood volume were evaluated preoperatively and within the first 24 hours after DC.
Results:
There was a global trend toward improved cerebral hemodynamics after DC. Preoperative and postoperative absolute mean transit times were associated with mortality at 6 months, and the ratio of post- and preoperative cerebral blood flow was significantly higher in patients with favorable outcomes than those with unfavorable outcomes. Patients who underwent surgery 48 hours after stroke, those with midline brain shift>10 mm, and those who were >55 years showed no significant improvement in any perfusion CT parameters.
Conclusions:
DC improves cerebral hemodynamics in patients with malignant middle cerebral artery infarction, and the level of improvement is related to outcome. However, some patients did not seem to experience any additional hemodynamic benefit, suggesting that perfusion CT may play a role as a prognostic tool in patients undergoing DC after ischemic stroke.
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