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Large diameter hemicraniectomy does not improve long-term outcome in malignant infarction
Dominik Lehrieder1, Hans-Peter Müller2, Jan Kassubek2
1Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany. Lehrieder_D@ukw.de.
Journal of Neurology
|May 10, 2023
Summary
Large hemicraniectomy (HC > 14 cm) did not improve outcomes or reduce mortality in malignant cerebral infarction patients. Hemicraniectomy size was not a significant predictor of functional outcome in this study.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Decompressive hemicraniectomy is used for malignant cerebral infarction but optimal size is debated.
- Large hemicraniectomy (>14 cm) is preferred by some surgeons.
- This study compares outcomes of large vs. standard hemicraniectomy.
Purpose of the Study:
- To investigate if large hemicraniectomy (>14 cm) improves mortality and long-term functional outcomes compared to standard hemicraniectomy (≤14 cm).
Main Methods:
- Retrospective analysis of 130 patients from the DESTINY registry.
- Patients dichotomized into HC ≤14 cm and HC >14 cm groups.
- Primary outcome: modified Rankin scale (mRS) ≤4 at 12 months; secondary outcomes: mortality and complications.
Main Results:
- No significant differences in primary outcome (mRS ≤4) or mortality between HC ≤14 cm and HC >14 cm groups.
- Complication rates were similar (27.6% vs. 36.6%).
- Multivariable analysis showed age and infarct volume, not hemicraniectomy diameter, predicted outcome.
Conclusions:
- Large hemicraniectomy was not associated with improved outcomes or reduced mortality in unselected malignant MCA infarction patients.
- Further randomized trials are needed to determine if specific patients benefit from large hemicraniectomy.
Keywords:
Functional outcomeHemicraniectomyMalignant strokeMiddle cerebral artery infarctionSize of hemicraniectomy
