Published online before print January 5, 2004, doi: 10.1161/01.STR.0000109772.64650.18
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2004;35:539.)
© 2004 American Heart Association, Inc.
Original Contributions |
Hemicraniectomy for Massive Middle Cerebral Artery Territory Infarction
A Systematic Review
From the Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio (R.G.), and Department of Neurological Surgery (E.S.C), Department of Neurology (S.M., M.S.V.E.), and Sergievsky Center, College of Physicians and Surgeons (M.S.V.E.), Columbia University, New York, NY.
Reprint requests to Dr Mitchell S.V. Elkind, Neurological Institute, 710 W 168th St, Room 641, New York, NY 10032. E-mail mse13{at}columbia.edu
Background and Purpose— Hemicraniectomy and durotomy have been proposed in many small series to relieve intracranial hypertension and tissue shifts in patients with large hemispheric infarcts, thereby preventing death from herniation. Our objective was to review the literature to identify patients most likely to benefit from hemicraniectomy.
Methods— All available individual cases from the English literature were reviewed and analyzed to determine whether age, vascular territory of infarction, side of infarction, reported time to surgery, and signs of herniation predict outcome in patients after hemicraniectomy. All studies included were retrospective and uncontrolled; there were no randomized controlled trials.
Results— Of 15 studies screened, 12 studies describing 129 patients met the criteria for analysis; 9 patients treated at our institution were added, for a total of 138 patients. After a minimum follow-up of 4 months, 10 patients (7%) were functionally independent, 48 (35%) were mildly to moderately disabled, and 80 (58%) died or were severely disabled. Of 75 patients who were >50 years of age, 80% were dead or severely disabled compared with 32% of 63 patients 
50 years of age (P<0.00001). The timing of surgery, hemisphere infarcted, presence of signs of herniation before surgery, and involvement of other vascular territories did not significantly affect outcome.
Conclusions— Age may be a crucial factor in predicting functional outcome after hemicraniectomy in patients with large middle cerebral artery territory infarction.
Key Words: craniectomy • emergency treatment • stroke • surgical treatment
This article has been cited by other articles:
 |
|
 |
|
  V. Ramaswamy, V. Mehta, M. Bauman, L. Richer, P. Massicotte, and J. Y. Yager Decompressive Hemicraniectomy in Children With Severe Ischemic Stroke and Life-Threatening Cerebral Edema J Child Neurol, August 1, 2008; 23(8): 889 - 894. [Abstract] [PDF]
|
|
|
|
 |
|
 S. A. Mayer and S. Schwab Advances in Critical Care and Emergency Medicine 2007 Stroke, February 1, 2008; 39(2): 261 - 263. [Full Text] [PDF]
|
|
|
|
|
|
J. Bardutzky and S. Schwab Antiedema Therapy in Ischemic Stroke Stroke, November 1, 2007; 38(11): 3084 - 3094. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Juttler, S. Schwab, P. Schmiedek, A. Unterberg, M. Hennerici, J. Woitzik, S. Witte, E. Jenetzky, W. Hacke, and for the DESTINY Study Group Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): A Randomized, Controlled Trial Stroke, September 1, 2007; 38(9): 2518 - 2525. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Mayer Hemicraniectomy: A Second Chance on Life for Patients With Space-Occupying MCA Infarction Stroke, September 1, 2007; 38(9): 2410 - 2412. [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Schirmer, D. A. Hoit, and A. M. Malek Decompressive Hemicraniectomy for the Treatment of Intractable Intracranial Hypertension After Aneurysmal Subarachnoid Hemorrhage Stroke, March 1, 2007; 38(3): 987 - 992. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Lees and J. Dawson Advances in Emerging Therapies 2006 Stroke, February 1, 2007; 38(2): 219 - 221. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Dawson and M. Walters New and emerging treatments for stroke Br. Med. Bull., November 7, 2006; (2006) ldl011v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 October 24 Highlight and Commentary: Cerebral herniation months after decompressive craniotomy: How can this be? Neurology, October 24, 2006; 67(8): 1323 - 1323. [Full Text] [PDF]
|
|
|
|
|
|
A. A. Rabinstein, N. Mueller-Kronast, B. V. Maramattom, A. R. Zazulia, W. R. Bamlet, M. N. Diringer, and E.F.M. Wijdicks Factors predicting prognosis after decompressive hemicraniectomy for hemispheric infarction. Neurology, September 12, 2006; 67(5): 891 - 893. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Kastrau, M. Wolter, W. Huber, and F. Block Recovery From Aphasia After Hemicraniectomy for Infarction of the Speech-Dominant Hemisphere Stroke, April 1, 2005; 36(4): 825 - 829. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Ben-Hur, J. E. Cohen, A. A. Rabinstein, L. H. Schwamm, and Bob. S. Carter Case 5-2004: A Man with Slurred Speech and Left Hemiparesis N. Engl. J. Med., May 20, 2004; 350(21): 2213 - 2214. [Full Text] [PDF]
|
|