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World Neurosurg. 2018 Nov 4. pii: S1878-8750(18)32497-5. doi: 10.1016/j.wneu.2018.10.190. [Epub ahead of print]

Stereotactic Aspiration of Necrotic Brain Tissue for treating Malignant Middle Cerebral Artery Infarction: A Report of 13 consecutive Cases.

Author information

1
Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China; Department of emergency, the Fourth Affiliated Hospital of Nantong University (Yancheng City NO.1 People's Hospital), Jiangsu Province, China.
2
Department of neurology, Yancheng Clinical Institute, Xuzhou Medical University (Yancheng City NO.1 People's Hospital), Yancheng, JiangSu Province, China.
3
Department of emergency, the Fourth Affiliated Hospital of Nantong University (Yancheng City NO.1 People's Hospital), Jiangsu Province, China.
4
Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China.
5
Neurosurgery Department, Shanghai Clinical Center of Chinese Academy of Sciences, Shanghai, China. Electronic address: sunshujie11@126.com.
6
Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China. Electronic address: njhdwang@hotmail.com.

Abstract

OBJECTIVE:

This study aimed to evaluate the efficacy and safety of stereotactic aspiration of necrotic brain tissue for treating malignant middle cerebral artery infarction (MMI) in patients older than 60 years of age.

METHODS:

A total of 13 consecutive patients with MMI, with the mean age of 67±6.62 years, were enrolled in the study. These patients were treated with stereotactic aspiration of necrotic brain tissue within 72h from stroke onset between January 2016 and June 2017. The surgical results and clinical outcomes were evaluated in response to stereotactic aspiration of necrotic brain tissue.

RESULTS:

The mean pre-operative infarction volume in the patients was found to be 153.46±9.39ml according to the latest computed tomography(CT). The 30-day mortality was 2 out of 13 patients (15.4%). Patients were followed up for 6 months to evaluate the efficacy of stereotactic aspiration of necrotic brain tissue using modified Rankin Scale (mRS). Among the 11 surviving surgical patients, 6 (54.5%)had mRS of 3 (defined as moderate disability) , 4 (36.4%) had mRS of 4(defined as moderately severe disability) , and 1 (9.1%) had mRS of 5 (defined as severe disability) . The probability of 6-month unfavorable outcome, defined as mRS 5 or 6 (death), was 3 out of 13(23.1%).

CONCLUSIONS:

Our results suggest the stereotactic aspiration of necrotic brain tissue is an effective and safe method in MMI patients over 60 years of age.

KEYWORDS:

Decompressive hemicraniectomy; Large hemispheric infarction; malignant middle cerebral artery infarction; stereotactic aspiration

PMID:
30404052
DOI:
10.1016/j.wneu.2018.10.190

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