Outcome after decompressive craniectomy in patients with severe ischemic stroke

Decompressive craniectomy after space occupying infarction of the middle cerebral artery (MCA) tends to decrease mortality and increase functional outcome. The aim of this retrospective study was to evaluate mortality rates and functional outcome in our centre and to identify predictors of prognosis...

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Bibliographic Details
Published in:Acta neurochirurgica 2006-01, Vol.148 (1), p.31-37
Main Authors: Harscher, S, Reichart, R, Terborg, C, Hagemann, G, Kalff, R, Witte, O W
Format: Article
Language:English
Subjects:
Adult
Aged
Clinical outcomes
Craniotomy
Decompression, Surgical
Female
Follow-Up Studies
Humans
Infarction, Middle Cerebral Artery - mortality
Infarction, Middle Cerebral Artery - surgery
Male
Middle Aged
Quality of Life
Recovery of Function
Retrospective Studies
Surgery
Survival Rate
Treatment Outcome
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Summary:Decompressive craniectomy after space occupying infarction of the middle cerebral artery (MCA) tends to decrease mortality and increase functional outcome. The aim of this retrospective study was to evaluate mortality rates and functional outcome in our centre and to identify predictors of prognosis. The charts of 30 consecutive patients (6 women, 24 men, mean age 59.3 +/- 11.0 years) who underwent craniectomy after space occupying MCA-infarction from 1996 to 2002 were analyzed. Functional outcome was assessed by semistructured telephone interview as Barthel-Index, modified Rankin scale and extended Barthel-Index. Five patients (mean age 67.2 +/- 6.1 years) died within 5.2 +/- 2.4 days (range 2-8 days) after the first symptoms due to herniation. Nine patients (mean age 63.1 +/- 7.1 years) died 141.0 +/- 92.5 days (range 40-343) after stroke onset due to internal complications. 16 patients survived (mean surviving time 2.1 +/- 1.5 years, mean age 54.1 +/- 11.4 years). Mortality was related to age and the number of risk factors/comorbidity, and functional outcome was dependent on the number of risk factors/comorbidity. Our small observational, retrospective study suggests that hemicraniectomy in patients with space occupying MCA-infarction decreases mortality rate and increases functional outcome. Further randomized trials may prove useful to better define the indications, timing and prognosis for this procedure.
ISSN:0001-6268
0942-0940
DOI:10.1007/s00701-005-0617-0