Limiting Brain Shift in Malignant Hemispheric Infarction by Decompressive Craniectomy

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Decompressive craniectomy (DC) is a crucial intervention for malignant hemispheric infarction (MHI).
• Surgical technique variability and complications can impact DC effectiveness.
• Predicting and minimizing midline brain shift post-DC is essential for optimizing outcomes.

Purpose of the Study:

• To evaluate specific preoperative CT measurements for their association with postoperative midline brain shift following DC in MHI patients.
• To identify predictors of surgical success in DC for MHI.

Main Methods:

• Retrospective analysis of 72 patients with MHI who underwent DC at two medical centers.
• Measurement of craniectomy surface area, brain herniation, tissue thickness, ventricle diameter, infarction extension, and midline brain shifts (pre- and post-DC).
• Multiple linear regression analysis to determine factors associated with postoperative midline brain shift, excluding confounding variables.

Main Results:

• The average midline brain shift decreased from 8.7 mm pre-DC to 5.4 mm post-DC.
• Preoperative midline shift (coefficient 0.32, p=0.002) and extent of transcalvarial brain herniation (coefficient -0.20, p<0.001) were significantly associated with postoperative midline brain shift.
• Smaller preoperative shift and greater herniation predicted less postoperative shift.

Conclusions:

• In MHI patients undergoing DC, reduced postoperative midline shift correlates with smaller preoperative midline shift and more significant transcalvarial brain herniation.
• These findings can aid in patient selection and surgical planning for DC.
• Further research is needed to enhance the surgical success of DC for MHI.