Infarct volume predicts outcome after decompressive hemicraniectomy for malignant hemispheric stroke

Area of Science:

• Neurosurgery
• Neurology
• Stroke Medicine

Background:

• Decompressive hemicraniectomy (DHC) is a debated treatment for malignant hemispheric stroke (MHS).
• DHC often results in moderate to severe disability, necessitating better outcome prediction.
• Identifying independent predictors of functional status after DHC is crucial for patient selection and trial design.

Purpose of the Study:

• To identify independent predictors of functional outcome in patients with MHS undergoing DHC.
• To establish imaging-based prognostic markers for DHC in MHS.
• To determine a threshold for infarct volume to predict unfavorable outcomes.

Main Methods:

• Prospective cohort study of 96 MHS patients undergoing DHC.
• Functional outcome assessed using the modified Rankin Scale (mRS) at 12 months (favorable: mRS 0-3; unfavorable: mRS 4-6).
• Multivariable logistic and ordinal regression analyses incorporating neuroimaging data (infarct volume, thalamic involvement) and clinical factors (age, postoperative complications).

Main Results:

• Only 20% of patients achieved a favorable outcome (mRS 0-3) at 12 months.
• Independent predictors of unfavorable outcome included older age, larger infarct volume, thalamic involvement, and postoperative pneumonia.
• A threshold infarct volume of 270 cm³ was identified for predicting unfavorable outcomes.

Conclusions:

• Age, infarct volume, thalamic involvement, and postoperative pneumonia are significant predictors of DHC outcomes in MHS.
• An infarct volume exceeding 270 cm³ is a strong indicator of poor prognosis.
• These findings can aid in prognostication and inform the design of future clinical trials for DHC in MHS.