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Effect of decompressive hemicraniectomy in patients with acute middle cerebral artery infarction
Halil İbrahim Süner1, Anıl Tanburoğlu2, Emre Durdağ1
1Department of Neurosurgery, School of Medicine, Başkent University, Adana, Turkey
Insights
Early decompressive hemicraniectomy (DHC) improves survival and functional outcomes for patients with middle cerebral artery (MCA) infarction. Prompt DHC administration, especially in younger patients, is crucial for better results.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Decompressive hemicraniectomy (DHC) is a critical intervention for acute ischemic stroke.
- Determining optimal timing and patient selection for DHC remains a key challenge.
Purpose of the Study:
- To identify factors influencing the effectiveness of DHC in patients with middle cerebral artery (MCA) infarction.
- To compare outcomes between patients who survived and those who did not after DHC.
Main Methods:
- Retrospective analysis of 47 patients who underwent DHC for acute MCA infarction.
- Comparison of patient groups based on survival status, age, Glasgow Coma Scale (GCS) score, anisocoria, and time to treatment.
- Assessment of modified Rankin Scale (mRS) scores in relation to age.
Main Results:
- Patients who survived DHC had shorter times to hospitalization and higher admission GCS scores.
- Anisocoria at admission was significantly associated with mortality.
- Younger patients (< 60 years) demonstrated higher survival rates (61.5%) and better functional outcomes (median mRS 4) compared to older patients (> 60 years) (26.5% survival, median mRS 6).
Conclusions:
- Age, timing of DHC, and time to hospitalization are critical determinants of functional outcome and survival in MCA infarction.
- Early DHC intervention, particularly before neurological worsening or herniation, is recommended for improved survival in patients unresponsive to medical treatment.
Background/Aim:
We aimed to determine in which cases this procedure may be more effective based on the data of patients who underwent decompressive hemicraniectomy (DHC).
Material And Methods:
Overall, 47 patients who underwent DHC due to acute middle cerebral artery (MCA) infarction between January 2014 and january 2019 were retrospectively investigated. These patients were divided into two groups: those who died after DHC (Group A) and those who survived DHC (Group B). The groups were compared in terms of various parameters. We investigated whether the patient’s modified Rankin scale (mRS) status changed depending on age (> 60 and < 60 years).
Results:
The median age of all patients was 65 (37–80) years; groups A and B had median ages of 66.5 (37–80) and 61 (44–79) years (p = 0.111), respectively; 55.3% patients were male. The elapsed times until hospitalization after the onset of symptoms were 4.5 and 3 h in groups A and B, respectively (p = 0.014). The median GCS score at the time of admission was 7 (5–12) and 10 (8–14) in groups A and B, respectively (p = 0.0001). At the time of admission, 63.3% patients in group A had anisocoria, whereas no patient in group B had anisocoria (p = 0.0001). In postoperative period, 40% patients in group A and all patients in group B received AC/AA treatment. The survival of patients aged < 60 and > 60 years who underwent DHC for MCA infraction was 61.5% and 26.5%, respectively (p = 0,041). The median mRS of patients < 60 and > 60 years were 4 (1–6) and 6 (1–6), respectively (p = 0.018).
Conclusion:
Age, DHC timing, and elapsed time until hospitalization or access to treatment directly affect the functional outcome and survival in MCA-infarcted patients who underwent DHC. In patients in whom the medical treatment fails, early DHC administration will increase survival without waiting for neurological worsening once herniation is detected radiologically.
