10-Year Institutional Retrospective Case Series of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction (mMCAI)
| Autor: | Laura Osborne, Basel Al-Romhain, Edward J. St. George, Simon Lammy |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Decompressive Craniectomy medicine.medical_specialty Adolescent Decompression medicine.medical_treatment Glasgow Outcome Scale 030204 cardiovascular system & hematology Young Adult 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale medicine.artery medicine Humans Longitudinal Studies Retrospective Studies Intracranial pressure business.industry Glasgow Coma Scale Infarction Middle Cerebral Artery Middle Aged Magnetic Resonance Imaging Surgery Treatment Outcome Anesthesia Middle cerebral artery Number needed to treat Female Decompressive craniectomy Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 96:383-389 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2016.09.004 |
| Popis: | Background A 10-year (2005–2015) retrospective case series of patients undergoing decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI) was undertaken. Methods Patient demographics, comorbidities, pre- and postoperative neurologic state, operative timescales, craniectomy dimensions, and Glasgow Outcome Scale scores were analyzed. Results Overall 40 patients underwent a decompressive craniectomy for mMCAI with a 30-day mortality of 17.5% ( n = 7). Seventeen patients (42.5%) were male, with a mean age of 43 years (range: 16–64 years). Patients who survived had a lower mean age of 41 years (range: 16–59 years) than those who did not of 50 years (range: 42–63 years). The modal ictal and preoperative Glasgow Coma Scale scores were 14 (range: 5–15) and 7 (range: 3–12), which corresponded to motor scores of 6 and 5, respectively. The mean time from ictus to admission to the Institute of Neurological Sciences (INS) was 23.5 hours (range: 0.5–66 hours) and from INS admission to decompression 7.5 hours (range: 0.5–46 hours). Approximately 60% of patients had an “early” craniectomy (under 48 hours from ictus) and 60% of patients had a craniectomy performed less than 24 hours from INS admission. The mean maximum anteroposterior craniectomy diameter measured 13 cm (range: 10.93–15.12 cm) and the mean surface area was 92.68 cm 2 (range: 76.14–124.42 cm 2 ). Overall 80% of patients had a modal Glasgow Outcome Scale score of 3 (range: 2–5) at discharge, 3 months, 6 months, 9 months, and 12 months. The median length of stay was 3 days (range: 6 hours to 11 days) for nonsurvivors and 13 days (range: 1–365 days) for survivors. Conclusion Decompressive craniectomy for mMCAI is suitable in selected patients, and the local practice is consistent with current evidence. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect