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Large Size Hemicraniectomy Reduces Early Herniation in Malignant Middle Cerebral Artery Infarction
- Source :
- Cerebrovascular Diseases. 41:283-290
- Publication Year :
- 2016
- Publisher :
- S. Karger AG, 2016.
-
Abstract
- Background: Decompressive hemicraniectomy (DHC) reduces mortality and improves outcome after malignant middle cerebral artery infarction (MMI) but early in-hospital mortality remains high between 22 and 33%. Possibly, this circumstance is driven by cerebral herniation due to space-occupying brain swelling despite decompressive surgery. As the size of the removed bone flap may vary considerably between surgeons, a size too small could foster herniation. Here, we investigated the effect of the additional volume created by an extended DHC (eDHC) on early in-hospital mortality in patients suffering from MMI. Methods: We performed a retrospective single-center cohort study of 97 patients with MMI that were treated either with eDHC (n = 40) or standard DHC (sDHC; n = 57) between January 2006 and June 2012. The primary study end point was defined as in-hospital mortality due to transtentorial herniation. Results: In-hospital mortality due to transtentorial herniation was significantly lower after eDHC (0 vs. 11%; p = 0.04), which was paralleled by a significantly larger volume of the craniectomy (p < 0.001) and less cerebral swelling (eDHC 21% vs. sDHC 25%; p = 0.03). No statistically significant differences were found in surgical or non-surgical complications and postoperative intensive care treatment. Conclusion: Despite a more aggressive surgical approach, eDHC may reduce early in-hospital mortality and limit transtentorial herniation. Prospective studies are warranted to confirm our results and assess general safety of eDHC. �� In Copyright http://rightsstatements.org/vocab/InC/1.0/<br />publishedVersion
- Subjects :
- Male
Decompressive surgery
Time Factors
Hirninfarkt
medicine.medical_treatment
Skull
Surgery
Infarction
Brain Edema
030204 cardiovascular system & hematology
0302 clinical medicine
Risk Factors
Germany
Hospital Mortality
Prospective cohort study
Encephalocele
Kraniotomie
Infarction, Middle Cerebral Artery
Middle Aged
Treatment Outcome
Neurology
Cerebral infarction
Female
Space-occupying edema
Decompressive craniectomy
Cardiology and Cardiovascular Medicine
Craniotomy
Cohort study
Malignant middle cerebral artery infarction
Kraniotomie
Decompressive Craniectomy
medicine.medical_specialty
Hemicraniectomy
03 medical and health sciences
Middle Cerebral Artery Infarction
medicine
Humans
ddc:610
Retrospective Studies
business.industry
Retrospective cohort study
Protective Factors
medicine.disease
Cerebrovascular disorders
Neurology (clinical)
business
DDC 610 / Medicine & health
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 14219786 and 10159770
- Volume :
- 41
- Database :
- OpenAIRE
- Journal :
- Cerebrovascular Diseases
- Accession number :
- edsair.doi.dedup.....44b54355db32682a2df5dc6e1b0e720d