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Published on: July 5, 2011
Decompressive Craniectomy: the Right Call at the Right Moment
R Badea1, O Olaru1, A Ribigan1
1University and Emergency Hospital of Bucharest, Neurology Department, Bucharest, Romania.
Insights
Decompressive craniectomy can save lives in patients with severe stroke and brain swelling. Early intervention, especially for ischemic stroke in younger patients, may improve functional outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Massive intracerebral hemorrhages and large internal carotid artery infarcts can lead to fatal cerebral edema and increased intracranial pressure.
- Decompressive craniectomy offers a potential life-saving intervention for selected stroke patients.
Discussion:
- This paper presents two cases of decompressive craniectomy, one for hemorrhagic stroke within 24 hours and another for ischemic stroke after 72 hours.
- Analysis includes neurological status, Glasgow Coma Scale, CT scans, complications, and modified Rankin Scale at discharge.
- The timing of decompressive craniectomy is crucial for both survival and functional outcome.
Key Insights:
- Decompressive craniectomy is a life-saving procedure for stroke patients with severe edema and elevated intracranial pressure.
- Early intervention (within 48 hours) may improve functional outcomes, particularly in ischemic stroke patients under 60.
- While life-saving in both presented cases, functional outcomes varied based on stroke type and intervention timing.
Outlook:
- Further research is needed to optimize patient selection and timing for decompressive craniectomy.
- Establishing clear guidelines for decompressive craniectomy in different stroke types is essential.
- Investigating long-term functional outcomes and quality of life after decompressive craniectomy is warranted.
Abstract:
Introduction:Massive intracerebral hemorrhages and large internal carotid artery infarcts may cause early death due to severe cerebral edema with elevated intracranial pressure, despite maximal medical therapy. Decompressive craniectomy may be of benefit to these patients in terms of survival and even functional outcome. The aim of our paper is to present two cases that illustrate the use of decompressive craniectomy both in ischemic and hemorrhagic stroke, followed by a discussion on the indication and right timing of the intervention, but also on the outcome of these patients. Materials and methods: We present the cases of a 38-year-old man with a right lenticular and capsular hemorrhage who underwent decompressive craniectomy in the first 24 hours from onset of symptoms and a 64-year-old patient with an ischemic stroke in the territory of the left carotid artery with a decompressive craniectomy performed at more than 72 hours from the beginning. For each of the two cases, we analyzed the following parameters: neurologic status, Glasgow Coma Scale, aspect of the cerebral computed tomography before and after surgery, in-hospital complications and modified Rankin Scale at discharge. Outcomes: While the intervention was life-saving in both cases, the procedure had different functional outcomes. Conclusion: Decompressive craniectomy may be a life-saving procedure for patients with both hemorrhagic or ischemic strokes complicated with massive edema and increased intracranial pressure. When performed in the first 48 hours, especially in patients with ischemic stroke aged less than 60, it may also improve the functional outcome compared to conservative treatment.
