Decompressive hemicraniectomy in ischaemic stroke |
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| Authors: | Maciej Świat Magdalena Targosz-Gajniak Michał Arkuszewski Małgorzata Pięta Jacek Gamrot Maciej Wojtacha Piotr Bażowski Grzegorz Opala |
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| Affiliation: | 1. Klinika Neurologii Wieku Podesz?ego, ?l?ski Uniwersytet Medyczny w Katowicach, SP Centralny Szpital Kliniczny w Katowicach;2. Klinika Neurochirurgii, ?l?ski Uniwersytet Medyczny w Katowicach, SP Centralny Szpital Kliniczny w Katowicach;1. Department of Neurosurgery, Padua University Hospital, Padua, Italy;2. Department of Neuroradiology, Padua University Hospital, Padua, Italy;2. University Medical Center at Brackenridge, Austin, Texas;1. Orbital and Oculoplastic Department, The Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China;2. Discipline of Ophthalmology and Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia;3. Ophthalmic Department, Quzhou People''s Hospital, Quzhou, Zhejiang, China;4. Second Hospital of Zhengzhou City, Henan Province, China;1. Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA;2. Department of Neurological Surgery, University of California, San Francisco, California, USA;3. Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA;1. Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil;2. Massachusetts Eye and Ear Infirmary, Department of Otolaryngology-Head and Neck Surgery, Boston, United States;3. Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasília, DF, Brazil;4. Harvard Medical School, Department of Otology and Laryngology, Boston, United States;5. Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil;6. Harvard Medical School, Massachusetts Eye and Ear Infirmary, Ophthalmic Plastic Surgery Service, Boston, United States |
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| Abstract: | Background and purposeHemispheric ischaemic stroke complicated by oedema is associated with high mortality. The results of randomized studies showed that decompressive hemicraniectomy performed in this group of patients could be beneficial. First experiences with implementation of hemicraniectomy in patients with brain infarct in our stroke centre are presented.Material and methodsBetween August 2007 and July 2008, four patients with hemispheric brain infarcts complicated by malignant oedema underwent decompressive hemicraniectomy within 72 hours from symptoms onset. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Clinical outcome was assessed 3, 6 and 12 months after the event using the modified Rankin scale (mRS).ResultsIn the first patient, the neurosurgical procedure included only decompressive hemicraniectomy, whereas in the other three duraplasty was performed additionally. The first patient died 23 days after the stroke onset due to acute respiratory failure. Another died at four months after the event, due to infectious complications. The remaining two patients presented severe functional disability 12 months after the procedure (mRS score 4).ConclusionsDecompressive surgery with duraplasty can be a life-saving procedure for patients with brain oedema. To our knowledge, the presented cases are among the first reported cases of hemispheric ischaemic stroke treated with decompressive hemicraniectomy in Poland. Extended follow-up with a larger group of patients is necessary to assess long-term outcome. |
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| Keywords: | decompressive craniectomy stroke stroke management brain oedema kraniektomia odbarczaj?ca udar mózgu leczenie udaru mózgu obrz?k mózgu |
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