pmc logo image
Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryCurrent TOCInstructions for authors
Journal List > J Neurol Neurosurg Psychiatry > v.75(2); Feb 2004

Formats:
J Neurol Neurosurg Psychiatry. 2004 February; 75(2): 270–274.
PMCID: PMC1738890
Copyright notice
Outcome and prognostic factors of hemicraniectomy for space occupying cerebral infarction
E Uhl, F Kreth, B Elias, A Goldammer, R Hempelmann, M Liefner, G Nowak, M Oertel, K Schmieder, and G Schneider
Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany. Email: euhl/at/nc.med.uni-muenchen.de
Small right arrow pointing to: This article has been cited by other articles in PMC.
Abstract
Objective: To determine long term functional outcome and length of survival of patients undergoing decompressive craniectomy for space occupying infarction of the middle cerebral artery (MCA), and to identify risk factors associated with death and unfavourable outcomes
Methods: Databases of patients undergoing decompressive craniectomy for space occupying MCA infarction compiled at eight neurosurgical departments (1996–2001) were merged, and 188 patients were evaluated. Mortality was calculated by the Kaplan–Meier method. Clinical outcome was rated using the Glasgow outcome scale (GOS). The prognostic impact of patient related covariates on length of survival and the GOS was analysed multivariately.
Results: The unadjusted 3, 6, and 12 month mortality rates were 7.9%, 37.6%, and 43.8%, respectively (median follow up, 26 weeks). In the "best" multivariate model, age >50 years (p<0.02) and the involvement of two or more additional vascular territories (p<0.01) had an unfavourable impact on length of survival. The adjusted six month mortality was as low as 20.0% (no risk factor) and as high as 59.7% (two risk factors). A GOS score of [less-than-or-eq, slant]3 was significantly associated with age >50 years (p<0.0003): 34.9% of the patients [less-than-or-eq, slant]50 years of age achieved a GOS score of >3, as compared with 12.0% of the elderly subpopulation. The side of the infarct did not have prognostic relevance.
Conclusions: Results of surgical treatment in patients <50 years of age undergoing decompressive craniectomy are encouraging. The effectiveness of decompressive craniectomy for patients >50 years remains questionable and should be analysed in the framework of a prospective randomised study.
Full Text
The Full Text of this article is available as a PDF (206K).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
  • Berrouschot J, Sterker M, Bettin S, Köster J, Schneider D. Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care. Intensive Care Med. 1998 Jun;24(6):620–623. [PubMed]
  • 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 Apr;53(4):309–315. [PubMed]
  • Rieke K, Schwab S, Krieger D, von Kummer R, Aschoff A, Schuchardt V, Hacke W. Decompressive surgery in space-occupying hemispheric infarction: results of an open, prospective trial. Crit Care Med. 1995 Sep;23(9):1576–1587. [PubMed]
  • Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke. 1998 Sep;29(9):1888–1893. [PubMed]
  • Carter BS, Ogilvy CS, Candia GJ, Rosas HD, Buonanno F. One-year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery. 1997 Jun;40(6):1168–1176. [PubMed]
  • Lindegaard KF, Røste GK. Livreddende hemikraniektomi ved akutt massivt hjerneinfarkt. Tidsskr Nor Laegeforen. 1999 Nov 20;119(28):4190–4192. [PubMed]
  • Sollid S, Kloster R, Ingebrigtsen T. Dekomprimerende kraniektomi--livreddende behandling ved akutt hjerneinfarkt. Tidsskr Nor Laegeforen. 1999 Nov 20;119(28):4199–4201. [PubMed]
  • Young PH, Smith KR, Jr, Dunn RC. Surgical decompression after cerebral hemispheric stroke: indications and patient selection. South Med J. 1982 Apr;75(4):473–475. [PubMed]
  • Greenwood J., Jr Acute brain infarctions with high intracranial pressure: surgical indications. Johns Hopkins Med J. 1968 May;122(5):254–260. [PubMed]
  • Mori K, Aoki A, Yamamoto T, Horinaka N, Maeda M. Aggressive decompressive surgery in patients with massive hemispheric embolic cerebral infarction associated with severe brain swelling. Acta Neurochir (Wien). 2001;143(5):483–492. [PubMed]
  • Rengachary SS, Batnitzky S, Morantz RA, Arjunan K, Jeffries B. Hemicraniectomy for acute massive cerebral infarction. Neurosurgery. 1981 Mar;8(3):321–328. [PubMed]
  • Kondziolka D, Fazl M. Functional recovery after decompressive craniectomy for cerebral infarction. Neurosurgery. 1988 Aug;23(2):143–147. [PubMed]
  • Steiger HJ. Outcome of acute supratentorial cerebral infarction in patients under 60. Development of a prognostic grading system. Acta Neurochir (Wien). 1991;111(3-4):73–79. [PubMed]
  • Holtkamp M, Buchheim K, Unterberg A, Hoffmann O, Schielke E, Weber JR, Masuhr F. Hemicraniectomy in elderly patients with space occupying media infarction: improved survival but poor functional outcome. J Neurol Neurosurg Psychiatry. 2001 Feb;70(2):226–228. [PubMed]
  • Walz Birgit, Zimmermann Carolin, Böttger Stefanie, Haberl Roman L. Prognosis of patients after hemicraniectomy in malignant middle cerebral artery infarction. J Neurol. 2002 Sep;249(9):1183–1190. [PubMed]
  • Steiner T, Ringleb P, Hacke W. Treatment options for large hemispheric stroke. Neurology. 2001;57(5 Suppl 2):S61–S68. [PubMed]
  • Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. [PubMed]
  • Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975 Mar 1;1(7905):480–484. [PubMed]
Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of
BMJ Group

PubMed articles by these authors

Links