Document Detail

Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review.
MedLine Citation:
PMID:  14707232     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Hemicraniectomy and durotomy have been proposed in many small series to relieve intracranial hypertension and tissue shifts in patients with large hemispheric infarcts, thereby preventing death from herniation. Our objective was to review the literature to identify patients most likely to benefit from hemicraniectomy. METHODS: All available individual cases from the English literature were reviewed and analyzed to determine whether age, vascular territory of infarction, side of infarction, reported time to surgery, and signs of herniation predict outcome in patients after hemicraniectomy. All studies included were retrospective and uncontrolled; there were no randomized controlled trials. RESULTS: Of 15 studies screened, 12 studies describing 129 patients met the criteria for analysis; 9 patients treated at our institution were added, for a total of 138 patients. After a minimum follow-up of 4 months, 10 patients (7%) were functionally independent, 48 (35%) were mildly to moderately disabled, and 80 (58%) died or were severely disabled. Of 75 patients who were >50 years of age, 80% were dead or severely disabled compared with 32% of 63 patients <or=50 years of age (P<0.00001). The timing of surgery, hemisphere infarcted, presence of signs of herniation before surgery, and involvement of other vascular territories did not significantly affect outcome. CONCLUSIONS: Age may be a crucial factor in predicting functional outcome after hemicraniectomy in patients with large middle cerebral artery territory infarction.
Rishi Gupta; E Sander Connolly; Stephan Mayer; Mitchell S V Elkind
Publication Detail:
Type:  Journal Article; Review     Date:  2004-01-05
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  35     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-03     Completed Date:  2004-04-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  539-43     Citation Subset:  IM    
Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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MeSH Terms
Age Factors
Brain Edema / etiology,  surgery
Decompression, Surgical*
Follow-Up Studies
Infarction, Middle Cerebral Artery / complications,  surgery*
Intracranial Hypertension / etiology,  surgery*
Middle Aged
Retrospective Studies
Survival Rate
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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