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. 2023 Apr;81(4):345-349.
doi: 10.1055/s-0043-1764415. Epub 2023 May 9.

Time course of hemispheric cerebral volume after decompressive craniectomy in malignant middle cerebral artery stroke

Thiago Pereira Rodrigues  1 , Mariana Athaniel Silva Rodrigues  2 , Leonardo Favi Bocca  1 , Feres Eduardo Chaddad Neto  1 , Sergio Cavalheiro  1 , Edson Amaro Júnior  2 , Gisele Sampaio Silva  1   3 , Italo Capraro Suriano  1 , Ricardo Silva Centeno  1
Affiliations

Time course of hemispheric cerebral volume after decompressive craniectomy in malignant middle cerebral artery stroke

Thiago Pereira Rodrigues et al. Arq Neuropsiquiatr. 2023 Apr.

Abstract
in English, Portuguese

Background: Brain edema is the leading cause of death in patients with malignant middle cerebral artery (MCA) infarction. Midline shift (MLS) has been used as a monohemispheric brain edema marker in several studies; however, it does not precisely measure brain edema. It is now possible to directly measure hemisphere brain volume. Knowledge about the time course of brain edema after malignant middle cerebral artery infarction may contribute to the condition's management.

Objective: Therefore, our goal was to evaluate the course of brain edema in patients with malignant MCA infarction treated with decompressive craniectomy (DC) using hemispheric volumetric measurements.

Methods: Patients were selected consecutively from a single tertiary hospital between 2013 and 2019. All patients were diagnosed with malignant middle cerebral artery infarction and underwent a decompressive craniectomy (DC) to treat the ischemic event. All computed tomography (CT) exams performed during the clinical care of these patients were analyzed, and the whole ischemic hemisphere volume was calculated for each CT scan.

Results: We analyzed 43 patients (197 CT exams). Patients' mean age at DC was 51.72 [range: 42-68] years. The mean time between the ischemic ictus and DC was 41.88 (range: 6-77) hours. The mean time between the ischemic event and the peak of hemisphere volume was 168.84 (95% confidence interval [142.08, 195.59]) hours.

Conclusion: In conclusion, the peak of cerebral edema in malignant MCA infarction after DC occurred on the 7th day (168.84 h) after stroke symptoms onset. Further studies evaluating therapies for brain edema even after DC should be investigated.

Antecedentes: O edema cerebral é a principal causa de morte em pacientes com infarto maligno de artéria cerebral média. O desvio da linha média tem sido utilizado como marcador de edema cerebral mono-hemisférico em alguns estudos; porém, ele não mede de forma precisa o edema cerebral. Atualmente é possível mensurar diretamente o volume do hemisfério cerebral. O conhecimento sobre a evolução temporal do edema cerebral após infartos malignos da artéria cerebral média pode contribuir para o cuidado clínico desta condição.

Objetivo: Nosso objetivo é avaliar o edema hemisférico ao longo do tempo, em pacientes com infarto maligno da artéria cerebral média, tratados com craniectomia descompressiva. MéTODOS: Os pacientes foram selecionados de forma consecutiva, em um hospital terciário, entre 2013 e 2019. Todos os pacientes apresentavam diagnóstico de infarto maligno de artéria cerebral média e foram submetidos a craniectomia descompressiva. Todas as tomografias computadorizadas de crânio destes pacientes foram analizadas, e o volume do hemisfério cerebral infartado foi mensurado.

Resultados: Analisamos 43 pacientes (197 tomografias de crânio). A idade média dos pacientes na craniectomia descompressiva foi 51,72 (42–68) anos. O tempo médio entre o ictus e a craniectomia descompressiva foi 41,88 (6–77) horas. O tempo médio entre o ictus e o pico do volume hemisférico foi 168,84 (142,08–195,59) horas. CONCLUSãO: O pico do volume cerebral em pacientes com infarto maligno de artéria cerebral média submetidos a craniectomia descompressiva ocorreu no 7o dia (168,84 horas) após o infarto. Mais estudos avaliando terapêuticas direcionadas ao edema cerebral seriam úteis neste contexto.

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Conflict of interest statement

The authors have no conflict of interests to declare.

Figures

Figure 1
Figure 1
The light green area represents the segmented right hemisphere after decompressive craniectomy, in a postoperative computed tomography exam.
Figure 2
Figure 2
Each colored line represents the course of a single patient.
See this image and copyright information in PMC

Comment in

References

    1. Schwab S, Steiner T, Aschoff A. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke. 1998;29(09):1888–1893. - PubMed
    1. 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(04):309–315. - PubMed
    1. Dohmen C, Galldiks N, Bosche B, Kracht L, Graf R. The severity of ischemia determines and predicts malignant brain edema in patients with large middle cerebral artery infarction. Cerebrovasc Dis. 2012;33(01):1–7. - PubMed
    1. Silver F L, Norris J W, Lewis A J, Hachinski V C. Early mortality following stroke: a prospective review. Stroke. 1984;15(03):492–496. - PubMed
    1. Shaw C M, Alvord E C, Jr, Berry R G. Swelling of the brain following ischemic infarction with arterial occlusion. Arch Neurol. 1959;1:161–177. - PubMed