Document Type : Short Communication
Authors
- Ahmad Soltani 1
- Mohammad Ali Mashari 2
- Seyed Ehsan Mohammadianinejad 3
- Seyed Amirhossein Pishva 4
- Seyedeh Maryam Pishva 1
- Etrat Hooshmandi 5
1 Department of Neurosurgery, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Neurosurgery, Persian Gulf Hospital, Bandar Abbas, Iran
3 Department of Neurology, School of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran
4 Department of Life Sciences, McMaster University, Hamilton, Canada
5 Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: This study aimed to compare the functional outcome of patients with malignant middle cerebral artery (MCA) infarction who had undergone either early decompressive craniectomy (DC) or optimal medical therapy (OMT).
Methods: This study was conducted during a 2-year period in Golestan Hospital of Ahvaz, Iran. The selected patients with malignant MCA infarction who were admitted within 48 hours of presenting signs were included. The patients were randomly assigned to undergo either early DC (n = 12) or OMT (n = 12) in the neurosurgical intensive care unit (ICU). The functional outcomes in the subjects were evaluated with the Glasgow Outcome Scale (GOS) and the National Institutes of Health Stroke Scale (NIHSS) at discharge, 6, and 12-month intervals.
Results: The patients who underwent DC had significantly higher GOS at discharge (P = 0.013),
6 (P = 0.022), and 12 (P = 0.042) months as compared to the medical therapy group. However, the NIHSS score did not show any significant difference between the two groups during the study. Likewise, DC was associated with lower mortality at 6 (P = 0.027) and 12 (P = 0.014) months; moreover, the lower mortality rate (P = 0.014), severe disability (P = 0.040), higher good recovery (P < 0.001), and moderate disability (P < 0.001) were observed after 12 months of follow-up.
Conclusion: These findings suggest that early DC in patients with malignant MCA can decrease mortality and improve the functional outcome according to GOS criteria compared to medical therapy.
Keywords
- Heiss WD. Malignant MCA infarction: Pathophysiology and imaging for early diagnosis and management decisions. Cerebrovasc Dis 2016; 41(1-2): 1-7.
- Li YP, Hou MZ, Lu GY, Ciccone N, Wang XD, Dong L, et al. Neurologic functional outcomes of decompressive hemicraniectomy versus conventional treatment for malignant middle cerebral artery infarction: A systematic review and meta-analysis. World Neurosurg 2017; 99: 709-25.
- Crudele A, Shah SO, Bar B. Decompressive hemicraniectomy in acute neurological diseases. J Intensive Care Med 2016; 31(9): 587-96.
- Das S, Mitchell P, Ross N, Whitfield PC. Decompressive hemicraniectomy in the treatment of malignant middle cerebral artery infarction: A meta-analysis. World Neurosurg 2019; 123: 8-16.
- Gul W, Fuller HR, Wright H, Sen J. A systematic review and meta-analysis of the effectiveness of surgical decompression in treating patients with malignant middle cerebral artery infarction. World Neurosurg 2018; 120: e902-20.
- Paliwal P, Kazmi F, Teoh HL, Yeo LLL, Seet RCS, Yeo TT, et al. Early Decompressive hemicraniectomy for malignant middle cerebral artery infarction in Asian patients: A single-center study. World Neurosurg 2018; 111: e722-e728.
- Bongiorni GT, Hockmuller MCJ, Klein C, Antunes ACM. Decompressive craniotomy for the treatment of malignant infarction of the middle cerebral artery: Mortality and outcome. Arq Neuropsiquiatr 2017; 75(7): 424-8.
- Qureshi AI, Suarez JI, Yahia AM, Mohammad Y, Uzun G, Suri MF, et al. Timing of neurologic deterioration in massive middle cerebral artery infarction: A multicenter review. Crit Care Med 2003; 31(1): 272-7.
- Wijdicks EF, Diringer MN. Middle cerebral artery territory infarction and early brain swelling: progression and effect of age on outcome. Mayo Clin Proc 1998; 73(9): 829-36.
- Kilic M, Ertem DH, Ozdemir B. Timing of decompressive craniectomy for malignant middle cerebral artery infarction: A single-center analysis. Medicina (Kaunas) 2019; 55(2): 31.
- Dasenbrock HH, Robertson FC, Vaitkevicius H, Aziz-Sultan MA, Guttieres D, Dunn IF, et al. Timing of decompressive hemicraniectomy for stroke: A nationwide inpatient sample analysis. Stroke 2017; 48(3): 704-11.
- Hofmeijer J, Amelink GJ, Algra A, van Gijn J, Macleod MR, Kappelle LJ, et al. Hemicraniectomy after middle cerebral artery infarction with life-threatening Edema trial (HAMLET). Protocol for a randomised controlled trial of decompressive surgery in space-occupying hemispheric infarction. Trials 2006; 7: 29.
- Frank JI, Schumm LP, Wroblewski K, Chyatte D, Rosengart AJ, Kordeck C, et al. Hemicraniectomy and durotomy upon deterioration from infarction-related swelling trial: Randomized pilot clinical trial. Stroke 2014; 45(3): 781-7.
- Vahedi K. Decompressive hemicraniectomy for malignant hemispheric infarction. Curr Treat Options Neurol 2009; 11(2): 113-9.
- Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 2007; 38(9): 2506-17.
- Zhao J, Su YY, Zhang Y, Zhang YZ, Zhao R, Wang L, et al. Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old. Neurocrit Care 2012; 17(2): 161-71.
- Young FB, Lees KR, Weir CJ. Improving trial power through use of prognosis-adjusted end points. Stroke 2005; 36(3): 597-601.
- Chen CC, Cho DY, Tsai SC. Outcome of and prognostic factors for decompressive hemicraniectomy in malignant middle cerebral artery infarction. J Clin Neurosci 2007; 14(4): 317-21.
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