Decompressive craniectomy: Comparative analysis between surgical time and better prognosis.

Autor:	Bem Junior LS; Department of Neurosurgery, Hospital da Restauração, Recife, Brazil.; Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil.; College of Medical Sciences, Unifacisa University Center, Campina Grande, Brazil., Silva ACV; Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil., de Menezes MD; College of Medical Sciences, Pernambucana College of Healthy, Recife, Brazil., Galvão MJTC; College of Medical Sciences, Federal University of Pernambuco, Recife, Brazil., Ferreira Neto ODC; College of Medical Sciences, Catholic University of Pernambuco, Recife, Brazil., de Alencar Neto JF; College of Medical Sciences, Unifacisa University Center, Campina Grande, Brazil., Rabelo NN; Department of Neurosurgery, University of São Paulo, São Paulo, Brazil., Almeida NS; Department of Neurosurgery, Hospital da Restauração, Recife, Brazil.; Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil., Valença MM; Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil., de Azevedo Filho HRC; Department of Neurosurgery, Hospital da Restauração, Recife, Brazil.; Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2022 Dec 15; Vol. 13, pp. 1041947. Date of Electronic Publication: 2022 Dec 15 (Print Publication: 2022).
DOI:	10.3389/fneur.2022.1041947
Abstrakt:	Background: Malignant ischemic stroke is characterized by the involvement of 2/3 of the area of the middle cerebral artery, associated with cerebral edema, intracranial hypertension (ICH) and cerebral herniation, generating high morbidity and mortality. Over the years, several therapies have been studied in an attempt to reverse or reduce the damage caused by this vascular disorder, including decompressive craniectomy (DC), a surgical technique reserved for cases that evolve with refractory ICH. Methods: This study seeks to perform a comparative analysis on the effectiveness of decompressive craniectomy using four randomized clinical trials and the results found in the retrospective study conducted in a neurosurgical reference center between 2010 and 2018. Results: The total sample consisted of 263 patients, among which 118 were randomized and 145 were part of the retrospective study. The outcome was analyzed based on the modified Rankin Scale (mRS) for 6 and 12 months. The mean time to perform the DC was 28.4 h in the randomized trials, with the late approach (> 24 h) associated with unfavorable outcomes (mRS between 4 and 6). Conclusion: Compared to the aforementioned studies, the study by Bem Junior et al. shows that a surgical approach in < 12 h had a better outcome, with 70% of the patients treated early classified as mRS 2 and 3 at the end of 12 months (1). Decompressive craniectomy is currently the most effective measure to control refractory ICH in cases of malignant ischemic stroke, and the most appropriate approach before surgery is essential for a better prognosis for patients. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Bem Junior, Silva, Menezes, Galvão, Ferreira Neto, Alencar Neto, Rabelo, Almeida, Valença and Azevedo Filho.)
Databáze:	MEDLINE
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