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Decompressive hemicraniectomy for space-occupying brain infarction: Nationwide population-based registry study
Pablo Anke1, Lars Kjelsberg Pedersen2, Ellisiv B Mathiesen3
1Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
Summary
Decompressive hemicraniectomy for brain infarction shows comparable outcomes to clinical trials, but access varies by gender and region. Guidelines recommend its use, and outcomes in routine care align with trial results.
Area of Science:
- Neurosurgery
- Neurology
- Public Health
Background:
- Decompressive hemicraniectomy is a critical intervention for severe brain infarction.
- Assessing its real-world application and outcomes is vital for clinical practice and policy.
Purpose of the Study:
- To analyze nationwide data on decompressive hemicraniectomy for brain infarction in Norway.
- To compare outcomes with randomized controlled trials (RCTs) and assess guideline adherence.
Main Methods:
- Utilized data from the Norwegian Stroke Registry (NSR) for stroke cases operated between 2017-2019.
- Collected data on patient characteristics, treatment, and 3-month functional outcomes (modified Rankin Scale).
- Estimated crude treatment rates and inter-hospital transfer proportions.
Main Results:
- 68 patients underwent hemicraniectomy; 38.5% achieved favorable outcomes.
- Crude treatment rates varied geographically (0.29-1.40 per 100,000 population/year).
- Inter-hospital transfers (50%) were lower than anticipated (68%).
Conclusions:
- Identified gender and geographic disparities in access to decompressive hemicraniectomy.
- Outcomes in routine clinical settings were comparable to those in RCTs.
- Hemicraniectomy use aligned with current American Stroke Association guidelines.
