AI Article Synopsis

  • This study investigates the effectiveness of large hemicraniectomy (over 14 cm) vs. standard hemicraniectomy (14 cm or less) in treating malignant cerebral infarction to see if larger surgeries result in better outcomes or lower mortality rates.
  • The research analyzed data from the DESTINY registry, focusing on long-term functional outcomes and complications in a group of 130 patients.
  • The findings indicate that there were no significant differences in outcomes or complications between the two sizes of surgery, suggesting that larger hemicraniectomy may not offer additional benefits.

Article Abstract

Introduction: In malignant cerebral infarction decompressive hemicraniectomy has demonstrated beneficial effects, but the optimum size of hemicraniectomy is still a matter of debate. Some surgeons prefer a large-sized hemicraniectomy with a diameter of more than 14 cm (HC > 14). We investigated whether this approach is associated with reduced mortality and an improved long-term functional outcome compared to a standard hemicraniectomy with a diameter of less than 14 cm (HC ≤ 14).

Methods: Patients from the DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY) registry who received hemicraniectomy were dichotomized according to the hemicraniectomy diameter (HC ≤ 14 cm vs. HC > 14 cm). The primary outcome was modified Rankin scale (mRS) score ≤ 4 after 12 months. Secondary outcomes were in-hospital mortality, mRS ≤ 3 and mortality after 12 months, and the rate of hemicraniectomy-related complications. The diameter of the hemicraniectomy was examined as an independent predictor of functional outcome in multivariable analyses.

Results: Among 130 patients (32.3% female, mean (SD) age 55 (11) years), the mean hemicraniectomy diameter was 13.6 cm. 42 patients (32.3%) had HC > 14. There were no significant differences in the primary outcome and mortality by size of hemicraniectomy. Rate of complications did not differ (HC ≤ 14 27.6% vs. HC > 14 36.6%, p = 0.302). Age and infarct volume but not hemicraniectomy diameter were associated with outcome in multivariable analyses.

Conclusion: In this post-hoc analysis, large hemicraniectomy was not associated with an improved outcome or lower mortality in unselected patients with malignant middle cerebral artery infarction. Randomized trials should further examine whether individual patients could benefit from a large-sized hemicraniectomy.

Clinical Trial Registration Information: German Clinical Trials Register (URL: https://www.drks.de ; Unique Identifier: DRKS00000624).

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10345046PMC
http://dx.doi.org/10.1007/s00415-023-11766-3DOI Listing

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Article Synopsis
  • This study investigates the effectiveness of large hemicraniectomy (over 14 cm) vs. standard hemicraniectomy (14 cm or less) in treating malignant cerebral infarction to see if larger surgeries result in better outcomes or lower mortality rates.
  • The research analyzed data from the DESTINY registry, focusing on long-term functional outcomes and complications in a group of 130 patients.
  • The findings indicate that there were no significant differences in outcomes or complications between the two sizes of surgery, suggesting that larger hemicraniectomy may not offer additional benefits.
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