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Predicting Functional Outcome After Decompressive Craniectomy for Malignant Hemispheric Infarction: Clinical and

Askiel Bruno1, Nina Paletta2, Uttam Verma1

  • 1Department of Neurology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.

World Neurosurgery
|December 15, 2021
PubMed
Summary

Decompressive craniectomy (DC) for malignant hemispheric infarction (MHI) shows patient age and midline brain shift predict functional outcomes. Further studies are needed for stroke side and craniectomy barrier thickness.

Keywords:
Brain herniationCerebral edemaCraniectomyIschemic strokeStroke outcome

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Area of Science:

  • Neurosurgery
  • Neurology
  • Stroke Medicine

Background:

  • Decompressive craniectomy (DC) is a critical intervention for malignant hemispheric infarction (MHI).
  • Predicting functional outcomes after DC is essential for patient management.
  • Identifying prognostic factors can optimize treatment strategies.

Purpose of the Study:

  • To identify clinical and computed tomography (CT) predictors of functional outcome after DC for MHI.
  • To analyze factors influencing patient recovery 3-6 months post-stroke.

Main Methods:

  • Retrospective analysis of 66 patients undergoing DC for MHI at two stroke centers.
  • Inclusion criteria: DC for MHI, no additional procedures, and documented functional status.
  • Logistic regression used to analyze clinical factors and CT measurements for outcome prediction.

Main Results:

  • 53% of patients achieved acceptable functional outcomes (modified Rankin Scale <5).
  • Increasing patient age and post-DC midline brain shift significantly decreased the likelihood of acceptable outcomes.
  • Left-sided strokes and thicker craniectomy barriers showed non-significant trends toward poorer outcomes.

Conclusions:

  • Patient age and post-DC midline shift are valuable prognostic indicators for functional outcome after DC for MHI.
  • Stroke laterality and craniectomy barrier thickness warrant further prospective investigation for outcome prediction.