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COVID-19 and Decompressive Hemicraniectomy for Acute Ischemic Stroke
John W Liang1,2, Alexandra S Reynolds1,2, Kaitlin Reilly1,2
1Departments of Neurosurgery (J.W.L., A.S.R., K.R., C.L., C.P.K., T.S., J.G., S.M., J.B.B., J.M., N.S.D.), Icahn School of Medicine at Mount Sinai, New York, NY.
Stroke
|July 9, 2020
Summary
Decompressive hemicraniectomy can improve outcomes for young patients with malignant cerebral edema, even with COVID-19. A positive coronavirus disease 2019 test should not prevent potentially life-saving surgery.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Malignant cerebral edema in young patients often benefits from early decompressive hemicraniectomy.
- The influence of concurrent coronavirus disease 2019 (COVID-19) infection on surgical decisions for malignant cerebral edema is not well-defined.
Purpose of the Study:
- To evaluate the outcomes of decompressive hemicraniectomy in patients with malignant cerebral edema and COVID-19.
- To determine if COVID-19 status should influence the decision to perform hemicraniectomy.
Main Methods:
- Retrospective review of COVID-19-positive patients admitted to a neuroscience intensive care unit for malignant edema.
- Inclusion criteria: patients with >50% middle cerebral artery involvement on CT imaging indicating risk for malignant edema.
Main Results:
- Seven patients were monitored; 4 died due to COVID-19 complications, often outside the typical window for malignant swelling.
- Three patients underwent decompressive hemicraniectomy; one died postoperatively from cardiac failure, while two achieved good outcomes.
Conclusions:
- Decompressive hemicraniectomy can lead to favorable outcomes in COVID-19-positive patients with large hemispheric stroke.
- A positive COVID-19 test alone should not exclude patients from this potentially life-saving surgical intervention.
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