Outcomes After Decompressive Craniectomy for Ischemic Stroke: A Volumetric Analysis.

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Decompressive hemicraniectomy (DHC) treats space-occupying hemispheric infarcts.
• Current guidelines recommend DHC for patients under 60 within 48 hours of stroke onset.

Purpose of the Study:

• Evaluate neurologic outcomes following DHC.
• Assess the relationship between stroke volume and patient outcomes.

Main Methods:

• Retrospective review of 52 patients undergoing DHC (2016-2019).
• Volumetric analysis of infarct size using MRI and RAPID software.
• Outcomes assessed using modified Rankin Scale (mRS) at 90 days.

Main Results:

• Only 21.2% of patients achieved favorable outcomes (mRS ≤3).
• Surgery after 48 hours, age >60, and multivessel infarcts did not significantly impact outcomes.
• No patients with infarct volume >280 mL had favorable outcomes; a trend suggested smaller volumes correlate with better outcomes.

Conclusions:

• Current DHC guidelines may not optimize patient selection for malignant hemispheric infarct.
• Infarct volume appears to be a significant factor influencing DHC outcomes.
• Further research is needed to identify optimal candidates for DHC.