Document Detail

Early hemicraniectomy in patients with complete middle cerebral artery infarction.
MedLine Citation:
PMID:  9731614     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Malignant, space-occupying supratentorial ischemic stroke is characterized by a mortality rate of up to 80%. Several reports indicate a beneficial effect of hemicraniectomy in this situation. However, whether and when decompressive surgery is indicated in these patients is still a matter of debate. METHODS: In an open, prospective trial we performed hemicraniectomy in 63 patients with acute complete middle cerebral artery infarction. Initial clinical presentation was assessed by the Scandinavian Stroke Scale (SSS) and the Glasgow Coma Scale (GCS). All survivors were reexamined 3 months after surgical decompression, with the clinical evaluation graded according to the Rankin Scale (RS) and Barthel Index (BI). We analyzed the influence of early decompressive surgery (<24 hours after symptom onset, based on clinical status at admission and initial CT findings) versus late surgery (>24 hours after first reversible signs of herniation) on mortality, functional outcome, and the length of time of critical care therapy was needed. RESULTS: In total, 46 patients (73%) survived. Despite complete hemispheric infarction, no survivor suffered from complete hemiplegia or was permanently wheelchair bound. In patients with speech-dominant hemispheric infarction (n=11), only mild to moderate aphasia was present. The mean BI score was 65, and RS score revealed severe handicap in 13% of the patients. In 31 patients with early decompressive surgery, mortality was 16% and BI score 68.8. Early hemicraniectomy led to a significant reduction in the length of time critical care therapy was needed (7.4 versus 13.3 days, P<0.05). CONCLUSIONS: In general, the outcome of patients treated with craniectomy in severe ischemic hemispheric infarction was surprisingly good. In addition, early decompressive surgery may further improve outcome in these patients.
S Schwab; T Steiner; A Aschoff; S Schwarz; H H Steiner; O Jansen; W Hacke
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  29     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1998 Sep 
Date Detail:
Created Date:  1998-09-22     Completed Date:  1998-09-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1888-93     Citation Subset:  IM    
Department of Neurology, University of Heidelberg, Germany.
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MeSH Terms
Arterial Occlusive Diseases / radiography,  rehabilitation,  surgery
Brain Edema / radiography,  rehabilitation,  surgery
Cerebral Infarction / radiography,  rehabilitation,  surgery*
Decompression, Surgical*
Disability Evaluation
Intracranial Pressure
Middle Aged
Prospective Studies
Tomography, X-Ray Computed
Treatment Outcome

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