Background: Patient's age is considered to be one of the most relevant factors in selecting surgical candidates for decompressive hemicraniectomy after malignant hemispheric infarction. However, questions about surgical indication in older patients, patients with consciousness disorder or patients with large infarctions remain unanswered.
Objective: Our aim was to design a multifactorial scoring scale based on a combination of patient-specific factors in order to optimize the assessment of prognosis in patients after hemicraniectomy malignant strokes.
Methods: In this prospective observational study with a one-year follow-up, we assessed clinical and imaging data of patients who underwent decompressive hemicraniectomy due to malignant brain infarction. Barthel index was used as a single outcome measure to distinguish favorable vs. unfavorable outcomes. Associations between multiple variables and clinical outcome were assessed. Subsequently, a design of a predictive scoring system was proposed.
Results: Age of the patient, preoperative level of consciousness, midline shift, and volume of infarction showed a significant association with postoperative Barthel index. According to the identified factors, a multifactorial prognostic scoring system was introduced, aimed to distinguish between favorable and unfavorable outcomes. Using ROC analysis, it has achieved an AUC of 0.74 (95%CI 0.58‒0.89, p=0.01)CONCLUSIONS: Prediction of postoperative outcome should be based on multiple variables. Our scale, based on the clinical and imaging data, can be used during decision-making to estimate potential benefit of decompressive craniectomy in patients after malignant brain infarction (Tab. 5, Fig. 1, Ref. 32). Text in PDF www.elis.sk Keywords: decompressive hemicraniectomy, malignant hemispheric infarction, indication, outcome, prediction.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.4149/BLL_2024_45 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Blood pressure variability and functional outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction.
Eur J Neurol
January 2025
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Background And Purpose: Malignant middle cerebral artery infarction (MMI) is a severe condition with a high mortality rate. While decompressive hemicraniectomy has been demonstrated to reduce mortality, there is limited knowledge regarding blood pressure (BP) management following the surgery. This study aimed to investigate whether early blood pressure variability after surgery is associated with functional outcomes.
View Article and Find Full Text PDFIntracranial pressure trends and clinical outcomes after decompressive hemicraniectomy in malignant middle cerebral artery infarction.
Ann Intensive Care
November 2024
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Background: Malignant middle cerebral artery infarction (MMI) is associated with a high incidence of severe disability and mortality. Decompressive hemicraniectomy has become a recognized treatment that can improve the prognosis for patients if performed within a certain time window. Nevertheless, despite this intervention, a mortality rate of approximately 20-40% persists following the surgery.
View Article and Find Full Text PDFReduced brain oxygen response to spreading depolarization predicts worse outcome in ischaemic stroke.
Brain
November 2024
Department of Neurosurgery, Carl-von-Ossietzky University Oldenburg, Oldenburg, 26122, Germany.
Spreading depolarization (SD) describes a propagating neuronal mass depolarization within the cerebral cortex that represents a mediator of infarct development and strongly stimulates the metabolic rate of O2 consumption. Here, we investigated the influence of Spreading Depolarization (SD) on brain tissue partial pressure of O2 (ptiO2) within the peri-infarct tissue of patients suffering malignant hemispheric stroke (MHS). This prospective observational trial included 25 patients with MHS that underwent decompressive hemicraniectomy followed by subdural placement of electrodes for electrocorticography (ECoG) and neighboring implantation of a ptiO2 probe within the peri-infarcted cortex.
View Article and Find Full Text PDFNo difference in 6-month functional outcome between early and late decompressive craniectomies following acute ischaemic stroke in a national neurosurgical centre: a single-centre retrospective case-cohort study.
Ir J Med Sci
December 2024
Department of Anaesthetics and Intensive Care Medicine, Beaumont Hospital, Dublin, Ireland.
Background: Decompressive craniectomies (DCs) are recommended for the treatment of raised intracranial pressure after acute ischaemic stroke. Some studies have demonstrated improved outcomes with early decompressive craniectomy (< 48 h from onset) in patients with malignant cerebral oedema following middle cerebral artery infarction. Limited data is available on suboccipital decompressive craniectomy after cerebellar infarction.
View Article and Find Full Text PDFValidation and refinement of a predictive nomogram using artificial intelligence: assessing in-hospital mortality in patients with large hemispheric cerebral infarction.
Front Neurol
June 2024
Department of Neurology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
Background: Large Hemispheric Infarction (LHI) poses significant mortality and morbidity risks, necessitating predictive models for in-hospital mortality. Previous studies have explored LHI progression to malignant cerebral edema (MCE) but have not comprehensively addressed in-hospital mortality risk, especially in non-decompressive hemicraniectomy (DHC) patients.
Methods: Demographic, clinical, risk factor, and laboratory data were gathered.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!