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Neurologic Functional Outcomes of Decompressive Hemicraniectomy Versus Conventional Treatment for Malignant Middle
Yu-Ping Li1, Meng-Zhuo Hou2, Guang-Yu Lu3
1Department of Neurosurgery, The Clinical Medical College of Yangzhou University, Yangzhou, China; Neurosurgical Research, Department of Neurosurgery, Ludwig-Maximilians University of Munich, Munich, Germany.
Insights
Decompressive hemicraniectomy (DHC) improves outcomes for malignant middle cerebral artery (MCA) infarction patients compared to conventional treatment (CT). While DHC reduces mortality and improves good functional outcomes, older patients face higher risks of severe disability.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Malignant middle cerebral artery (MCA) infarction poses a high risk of mortality and severe disability.
- Conventional treatment (CT) has limited efficacy in managing the associated intracranial hypertension.
- Decompressive hemicraniectomy (DHC) is a surgical option to reduce intracranial pressure.
Purpose of the Study:
- To compare the efficacy of DHC versus CT in patients with malignant MCA infarction.
- To evaluate the impact of patient age and surgical timing on neurological function and mortality.
- To analyze functional outcomes and survival rates in different patient subgroups.
Main Methods:
- A systematic meta-analysis of randomized controlled trials and observational studies was conducted.
- Searched English and Chinese databases for studies published before August 2016.
- Key outcomes included good functional outcome (GFO), mortality, National Institutes of Health Stroke Scale, and Barthel index scores.
Main Results:
- DHC demonstrated statistically significant improvements in GFO and reduced mortality compared to CT.
- No significant difference was found in survival with severe disability between DHC and CT groups.
- Subgroup analysis revealed lower GFO and higher rates of severe disability in DHC patients over 60 years old.
Conclusions:
- DHC significantly improves GFO and reduces mortality in malignant MCA infarction patients of all ages compared to CT.
- DHC is associated with a higher incidence of moderately severe disability.
- Elderly patients (>60 years) with malignant MCA infarction have a poorer prognosis, with increased risk of severe disability and reduced GFO even with DHC.
Objective:
The aims of this study were to evaluate decompressive hemicraniectomy (DHC) versus conventional treatment (CT) for patients with malignant middle cerebral artery (MCA) infarction and to investigate the impact of age and surgical timing on neurologic function and mortality.
Methods:
We searched English and Chinese databases for randomized controlled trials or observational studies published before August 2016. Outcomes included good functional outcome (GFO), mortality, and National Institutes of Health Stroke Scale and Barthel index scores.
Results:
This meta-analysis included 25 studies (1727 patients). There were statistically significant differences between DHC and CT groups in terms of GFO (P < 0.0001), mortality (P < 0.00001), and National Institutes of Health Stroke Scale and Barthel index scores (P < 0.0001) at different follow-up points. Significant differences were observed between the groups in survival with moderately severe disability (P < 0.00001); no differences were observed in survival with severe disability. In the subgroup analysis, in the DHC group, GFO was less in patients >60 years old (9.65%) versus ≤60 years old (38.94%); more patients >60 years old had moderately severe or severe disability (55.27%) compared with patients ≤60 years old (44.21%).
Conclusions:
DHC could significantly improve GFO and reduces mortality of patients of all ages with malignant MCA infarction compared with CT, without increasing the number of patients surviving with severe disability. However, patients in the DHC group more frequently had moderately severe disability. Patients >60 years old with malignant MCA infarction had a higher risk of surviving with moderately severe or severe disability and less GFO.
