REMARK ON SOME FACTORS RELATED TO THE OUTCOMES OF DECOMPRESSIVE CRANIECTOMY IN PATIENTS WITH ISCHEMIC STROKE DUE TO MIDDLE CEREBRAL ARTERY OCCLUSION AT MILITARY CENTRAL HOSPITAL 108
DOI:
https://doi.org/10.59459/1859-1655/JMM.983Từ khóa:
Stroke, cerebral infarction, decompressive craniectomyTóm tắt
Objectives: To evaluate some factors related to the decompressive craniectomy in patients with ischemic stroke caused by middle cerebral artery occlusion
Subjects and methods: A retrospective descriptive, uncontrolled study combined with a prospective study was conducted on 31 patients with ischemic stroke due to middle cerebral artery occlusion who underwent decompressive craniectomy at Military Central Hospital 108 from January 2022 to December 2024.
Results: The mean time from stroke onset to surgery was 44.1 ± 26.0 hours. The rate of good outcomes was 56.3% in patients younger than 60 years, 47.4% in patients undergoing surgery within 48 hours, and 45.8% in patients with a midline shift of less than 10 mm. These rates were all higher than those observed in patients older than 60 years (13.3%), patients undergoing surgery after 48 hours (16.7%), and patients with midline shift greater than 10 mm (0%), respectively; the differences were statistically significant (p < 0.05). The rate of good outcomes among patients with preoperative Glasgow Coma Scale scores > 8 (43.7%) was higher than among those with scores ≤ 8 (26.7%), although the difference was not statistically significant (p > 0.05). Three out of 22 patients experienced seizures within 6 months after surgery.
Conclusion: Decompressive craniectomy for large territorial ischemic stroke caused by middle cerebral artery occlusion should be performed early, within 48 hours. Higher rates of good outcomes were observed in patients younger than 60 years old and in those with a midline shift of less than 10 mm.
Tài liệu tham khảo
1. Powers W.J, Rabinstein A.A, Ackerson T et al, “Guidelines for the early management of patients with acute ischemic stroke: A Guideline for Healthcare professionals from the American Heart Association/American Stroke Association”, Stroke, 49(3): e46-e110, 2018.
2. Jüttler E, Bösel J, Amiri H et al, “DESTINY II Study Group: DESTINY II: Decompressive surgery for the treatment of malignant INfarction of the middle cerebral arterY II, Int J Stroke, 6 (1): pp. 79-86, DOI: 10.1111/j.1747-4949.2010.00544, 2011.
3. Jain S., Iverson L.M, “Glasgow Coma Scale”, In: StatPearls [Internet], PMID: 30020670, Jun 12, 2023.
4. Liao C.C, Chen Y.F, Xiao F, “Brain midline shift measurement and its automation: A Review of techniques and algorithms”, Int J Biomed Imaging, 2018:4303161. doi: 10.1155/2018/4303161, PMID: 29849536; PMCID: PMC5925103. 2018.
5. Powers W.J, Derdeyn C.P, Biller J et al, “American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association”, Stroke, 46(10): pp. 3020-3035, 2015.
6. Goyal M, Menon B.K, van Zwam W. H et al, “Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials”, Lancet, 387 (10029): 1723-31, doi:10.1016/S0140-6736 (16)00163-X, PMID: 26898852, Feb 18, 2016.
7. Alhumaid L, Almaneea A, Al-Khalaf A et al, “Decompressive craniectomy is a life-saving procedure in malignant MCA infarction”. Neurosciences (Riyadh), 26(3): pp. 248-252, 2021.
8. Jüttler 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, 38(9): pp. 2518-2525, 2007.
9. 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, 38(9): pp. 2506-2517, 2007.
10. Das S, Mitchell P, Ross N, et al, “Decompressive hemicraniectomy in the treatment of malignant middle cerebral artery infarction: A Meta-Analysis”, World Neurosurg, 123: pp. 8-16, 2019.
11. Vahedi K, Hofmeijer J, Juettler E et al, “Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials”, Lancet Neurol, 6: pp. 215-222, 2007.
12. Mohan Rajwani K, Crocker M, Moynihan B, “Decompressive craniectomy for the treatment of malignant middle cerebral artery infarction”, Br J Neurosurg, 31(4): pp. 401-409, doi: 10.1080/02688697.2017.1329518. PMID: 28604106, 2017.
13. Uhl E, Kreth F. W, Elias B et al, Outcome and prognostic factors of hemicraniectomy for space occupying cerebral infarction, J Neurol Neurosurg Psychiatry, 75(2): pp. 270-274, 2004.
14. Van der Worp H. B, Hofmeijer J, Jüttler E et al, “European Stroke Organisation (ESO) guidelines on the management of space-occupying brain infarction”, Eur Stroke J, 6(2): XC-CX, doi: 10.1177/23969873211014112, 2021.
15. Paliwal P, Kazmi F, Teoh H.L et al, “Early decompressive hemicraniectomy for malignant middle cerebral artery infarction in Asian patients: A single-center study”, World Neurosurg, 111: e722-e728, 2018.
16. Raffiq M.A, Haspani M.S, Kandasamy R et al, “Decompressive craniectomy for malignant middle cerebral artery infarction: Impact on mortality and functional outcome”, Surg Neurol Int, 5: p.10, 2014.
17. Jeon S.B, Kwon S.U, Park J.C, et al, “Reduction of midline shift following decompressive hemicraniectomy for malignant middle cerebral artery infarction”, J Stroke, 18(3): pp. 328-336, 2016.
18. Kurland D.B, Khaladj-Ghom A, Stokum J.A et al, “Complications associated with decompressive craniectomy: A systematic review”, Neurocrit Care, 23(2): pp.292-304, 2015.
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Chấp nhận đăng 12-03-2026
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