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Proper Indication of Decompressive Craniectomy for the Patients with Massive Brain Edema after Intra-arterial

Sang-Hyuk Im1, Do-Sung Yoo1, Hae-Kwan Park1

  • 1Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Journal of Korean Neurosurgical Society
|January 4, 2024
PubMed

Insights

Decompressive craniectomy (DC) after intra-arterial thrombectomy (IA-Tx) for major infarction improves outcomes. Neurological status (Glasgow Coma Scale ≤7) and successful recanalization are key predictors, not the surgical time window.

Area of Science:

  • Neurology
  • Neurosurgery
  • Interventional Neuroradiology

Background:

  • Early decompressive craniectomy (DC) is recognized for improving outcomes in major infarction.
  • Previous studies predated the widespread use of intra-arterial thrombectomy (IA-Tx).
  • The impact of neurological status on DC outcomes post-IA-Tx requires clarification.

Purpose of the Study:

  • To evaluate the influence of neurological status on clinical outcomes in patients undergoing DC after IA-Tx for major infarction.
  • To identify key predictors of favorable outcomes in this patient cohort.

Main Methods:

  • Retrospective analysis of 67 patients with anterior circulation major infarction who underwent DC post-IA-Tx.
  • Review of medical records, radiological findings, and neurological status at surgery.
  • Comparison of outcomes based on surgical time window and neurological status (Glasgow Coma Scale).

Main Results:

  • A Glasgow Coma Scale (GCS) score of 7 or higher was associated with favorable outcomes (p=0.013).
  • Successful recanalization after IA-Tx (p=0.001) and pre-IA-Tx perfusion/diffusion mismatch (p=0.007) significantly predicted better outcomes.
  • The surgical time window (within 36 or 48 hours) did not correlate with neurological outcomes (p=0.389, p=0.283).

Conclusions:

  • Neurological status, specifically GCS ≥7, is a critical factor in selecting patients for DC following IA-Tx.
  • Early DC remains crucial, but its indication should incorporate neurological assessment to avoid unnecessary procedures.
  • Successful vessel recanalization and perfusion/diffusion mismatch are vital for long-term neurological recovery.
Abstract

Keywords:
Cerebral infarctionDecompressive craniectomyIntracranial pressureIschemic strokeMechanical thrombolysis

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