Decompressive craniectomy for malignant middle cerebral artery infarction at an emergency hospital in Peru
DOI:
https://doi.org/10.20453/rmh.v33i2.4245Keywords:
Middle cerebral artery, decompressive craniectomy, brain ischemiaAbstract
Objective: To describe clinical, surgical and post-operative characteristics in patients with the diagnosis of malignant infarction of the middle cerebral artery who underwent decompressive craniectomy. Methods: Descriptive, retrospective case series study, performed between March 2017 and March 2020. Data from consecutive patients with the diagnosis of malignant middle cerebral artery infarction were collected. Results: Ten cases were reviewed. Eighty percent of the patients were men, the mean age was 64 years and 60% of the patients were older than 60 years. At admission, the mean Glasgow was 11 points and the mean mRS was 4. The mean time from diagnosis to surgery was 89.7 hours. The anterior cerebral artery was comprised in two cases. Hemorrhagic transformation occurred in three cases. The mean anterior-posterior diameter of the skull flap was 116 mm. The mean ICU and hospital length of stay was 14.1 and 27.5 days, respectively. Three patients died. Conclusions: Decompressive craniectomy is a life-saving procedure in an emergency hospital-setting with an acceptable in-hospital mortality rate within one-month follow-up.
References
Johnson CO, Nguyen M, Roth GA, et al. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18(5):439–58.
Benjamin E, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019; 139(10): e56–528.
Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. “Malignant” Middle Cerebral Artery Territory Infarction: Clinical Course and Prognostic Signs. Arch Neurol. 1996; 53(4):309–15.
Treadwell SD, Thanvi B. Malignant middle cerebral artery (MCA) infarction: pathophysiology, diagnosis and management. Postgrad Med J. 2010; 86(1014): 235 LP-242.
Huttner HB, Schwab S. Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives. Lancet Neurol. 2009;8(10):949–58.
Wartenberg KE. Malignant middle cerebral artery infarction. Curr Opin Crit Care. 2012; 18(2) :152-63. doi: 10.1097/MCC.0b013e32835075c5.
Kasner S, Demchuk, Berrouschot J, et al. predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke. 2001 Sep 1; 32(9):2117–23.
Juttler E, Schwab S, Schmiedek P, et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke. 2007; 38(9):2518–25.
Vahedi K, Vicaut E, Mateo J, 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.
Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009; 8(4):326–33.
Vahedi K, Hofmeijer J, Juttler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007; 6(3):215–22.
Jüttler E, Unterberg A, Woitzik J, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014;3 70(12):1091–100.
Arac A, Blanchard V, Lee M, Steinberg GK. Assessment of outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 60 years of age. Neurosurg Focus FOC. 2009; 26(6):E3.
Yu JW, Choi J-H, Kim D-H, Cha J-K, Huh J-T. Outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 70 years old. J Cerebrovasc Endovasc Neurosurg. 2012; 14(2):65–74.
Zhao J, Su YY, Zhang Y, 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.
Castañeda-Guarderas A, Beltrán-Ale G, Casma-Bustamante R, Ruíz-Grosso P, Málaga G. Registro de pacientes con accidente cerebro vascular en un hospital público del Perú, 2000-2009. Rev Peru Med Exp Salud Publica. 2011; 28(4):623–7.
Alvarado-Dulanto CMA, Lazo M, Loza-Herrera JD, Malaga G. Pronóstico al año tras sufrir el debut de enfermedad cerebrovascular en pacientes de un hospital nacional de Lima, Perú. Rev Peru Med Exp y Salud Pública; 2015; 32(1):98-103.
Atamari-Anahui N, Alva-Diaz C, Vera-Monge V, Taype-Rondan A. Tendencia de mortalidad por enfermedad cerebrovascular registrada por el Ministerio de Salud de Perú, 2005-2015. Neurol Argentina. 2019; 11(4):202–9.
Neugebauer H, Fiss I, Pinczolits A, et al. Large size hemicraniectomy reduces early herniation in malignant middle cerebral artery infarction. Cerebrovasc Dis. 2016; 41(5–6):283–90.
Chung J, Bang OY, Lim YC, Park SK, Shin YS. Newly suggested surgical method of decompressive craniectomy for patients with middle cerebral artery infarction. Neurologist. 2011; 17(1):11-15.
Delashaw JB, Broaddus WC, Kassell NF, et al. Treatment of right hemispheric cerebral infarction by hemicraniectomy. Stroke. 1990; 21(6):874–81.
Sedney CL, Julien T, Manon J, Wilson A. The effect of craniectomy size on mortality, outcome, and complications after decompressive craniectomy at a rural trauma center. J Neurosci Rural Pract. 2014; 5(3):212–7.
Huang X, Wen L. Technical considerations in decompressive craniectomy in the treatment of traumatic brain injury. Int J Med Sci. 2010; 7(6):385–90
Downloads
Published
How to Cite
Issue
Section
License
Authors assign their rights to the RMH so that may disseminate the article through the means at their disposal. The journal will provide forms of affidavit of authorship and authorization for the publication of the article, which shall be submitted with the manuscript. Authors retain the right to share, copy, distribute, perform and publicly communicate their article, or part of it, mentioning the original publication in the journal.
