World Neurosurg. 2022 Feb 21:S1878-8750(22)00208-X. doi: 10.1016/j.wneu.2022.02.061. Online ahead of print.
ABSTRACT
Malignant ischemic stroke occurs in a subgroup of patients with cerebrovascular accident who suffer massive/significant cerebral infarction. It is characterized by neurological deterioration due to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique that can be used in treating select cases of this condition in the presence of medically refractory intracranial hypertension. This study aimed to identify prognostic factors associated with clinical outcome, such as timing of the procedure, and post-operative lethality. We analyzed surgical characteristics associated with the prognosis in 145 patients who underwent DC secondary to Malignant Ischemic Stroke (MIS) between 2013 and 2018, associating clinical outcome in discharge, 6 and 12 months after discharge. Our inclusion criteria were DC secondary to MIS in adult patients with raised intracranial pressure signs. This study reviewed a total of 145 patients who underwent DC to treat MIS. Our analysis showed that; even though patients from cities with more than 100 km from the neurosurgical center have a worse prognosis, only the surgical head side (left versus right,p=0.001), hospitalization length (p<0.001) and earlier timing of procedure (p<0.001) were statistically relevant in having worse outcomes. Patients who took more time to get started with the neurosurgical procedure, such as living in a distant city or taking more time to be seen by a specialist, tended to have a worse prognosis. The timing of procedure, surgical side, and hospitalization length were independent predictors in determining the prognosis of the patient who underwent DC after an MIS.
PMID:35202880 | DOI:10.1016/j.wneu.2022.02.061
