Radiologic and Blood Markers Predicting Long-Term Neurologic Outcome Following Decompressive Craniectomy for...

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Malignant ischemic stroke (MIS) involves severe cerebral edema and increased intracranial pressure (ICP).
• Decompressive craniectomy (DC) is a critical intervention for managing MIS and reducing mortality.
• Identifying predictive variables for neurologic outcomes post-DC in MIS patients is crucial.

Purpose of the Study:

• To identify pre- and postoperative predictors of neurologic outcomes in patients undergoing DC for MIS.
• To evaluate the association of inflammatory markers with functional outcomes after DC for MIS.

Main Methods:

• Retrospective analysis of 22 MIS patients who underwent DC between April 2016 and April 2020.
• Assessment of preoperative clinical status, laboratory data, and brain CT.
• Primary outcome: 6-month modified Rankin Scale (mRS); Secondary outcome: 30-day mortality.

Main Results:

• Lower postoperative neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocytes ratio (PLR) correlated with good 6-month mRS.
• Preoperative predictors of poor outcomes included advanced age, higher NIHSS scores, GCS < 8, and elevated PTT.
• Postoperative hydrocephalus was linked to 30-day mortality; persistent basal cistern compression trended towards higher mortality.

Conclusions:

• Decreased postoperative inflammatory markers predict better neurologic outcomes in MIS patients treated with DC.
• Preoperative factors like age, NIHSS, GCS, and PTT are independent predictors of poor outcomes.
• Postoperative hydrocephalus and basal cistern compression are associated with increased 30-day mortality.