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. 2023 Sep;81(9):778-784.
doi: 10.1055/s-0043-1772602. Epub 2023 Oct 4.

Outcomes of decompressive craniectomy for malignant middle cerebral artery stroke in an academic hospital in Brazil

Luiz Fernando Rodrigues de Oliveira  1 , Millene Rodrigues Camilo  1 , Luisa Franciscatto  1 , Guilherme Gozzoli Podolsky-Gondim  2 , Frederico Fernandes Alessio Alves  1 , Rui Kleber do Vale Martins Filho  1 , Francisco Antunes Dias  1 , Koji Tanaka  2 , Benedicto Oscar Colli  2 , Octávio Marques Pontes-Neto  1
Affiliations

Outcomes of decompressive craniectomy for malignant middle cerebral artery stroke in an academic hospital in Brazil

Luiz Fernando Rodrigues de Oliveira et al. Arq Neuropsiquiatr. 2023 Sep.

Abstract
in English, Portuguese

Background: Ischemic stroke is an important cause of death in the world. The malignant middle cerebral artery infarction (MMCAI) has mortality as high as 80% when clinically treated. In this setting, decompressive craniectomy is a life-saving measure, in spite of high morbidity among survivors.

Objective: To evaluate the outcomes of patients with MMCAI treated with decompressive craniectomy in a Brazilian academic tertiary stroke center.

Methods: A prospective stroke database was retrospectively evaluated, and all patients treated with decompressive craniectomy for MMCAI between January 2014 and December 2017 were included. The demographics and clinical characteristics were evaluated. The functional outcome, measured by the modified Rankin Scale (mRS), was assessed at hospital discharge, after 3-months and 1-year of follow-up.

Results: We included 53 patients on the final analysis. The mean age was 54.6 ± 11.6 years and 64.2% were males. The median time from symptoms to admission was 4.8 (3-9.7) hours and the mean time from symptoms to surgery was 36 ± 17 hours. The left hemisphere was the affected in 39.6%. The median NIHSS at admission was 20 (16-24). The in-hospital mortality was 30.2%. After a median of 337 [157-393] days, 47.1% of patients had achieved favorable outcome (mRS ≤ 4) and 39.6% had died.

Conclusion: Decompressive craniectomy is a life-saving measure in the setting of MMCAI, and its effects remains important in the scenario of a middle-income country in real-world situations.

Antecedentes: O acidente vascular cerebral (AVC) isquêmico é uma causa importante da morte em todo o mundo. O infarto maligno da artéria cerebral média (IMACM) tem mortalidade de até 80% quando tratado clinicamente. Nesse contexto, a craniectomia descompressiva é uma medida salvadora de vidas, apesar da alta morbidade entre os sobreviventes.

Objetivo: Avaliar os desfechos dos pacientes com IMACM tratados com craniectomia descompressiva em um centro acadêmico terciário de AVC no Brasil. MéTODOS: Um banco de dados prospectivo de AVC foi avaliado retrospectivamente e todos os pacientes tratados com craniectomia descompressiva para IMACM entre janeiro de 2014 e dezembro de 2017 foram incluídos. As características clínicas e demográficas foram avaliadas. Os desfechos funcionais, medidos pela escala modificada da Rankin (mRS), foram avaliados na alta hospitalar, após 3 meses e após 1 ano de seguimento.

Resultados: Foram incluídos 53 pacientes na análise final. A idade média foi 54,6 ± 11,6 anos e 64,2% eram homens. A mediana do tempo dos sintomas à admissão foi 4,8 (3–9,7) horas e o tempo médio dos sintomas à cirurgia foi 36 ± 17 horas. O hemisfério esquerdo foi o afetado em 39,6%. A pontuação na escala de AVC do National Institute of Health (NIHSS) à admissão foi 20 (16–24). A mortalidade hospitalar foi 30,2%. Após uma mediana de 337 (157–393) dias, 47,1% dos pacientes tinham atingido um desfecho favorável (mRS ≤ 4) e 39,6% tinham morrido. CONCLUSãO: Craniectomia descompressiva é uma medida salvadora de vidas no contexto do IMACM e seus efeitos permanecem importantes no cenário de um país em desenvolvimento em situação de vida real.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Modified Rankin scale (mRS) distribution at discharge, after 3-months, and after 1-year of stroke.
Figure 2
Figure 2
Modified Rankin scale (mRS) distribution at discharge, after 3-months, and after 1-year of stroke in the subgroup of patients younger than 60 years treated with decompressive craniectomy within 48 hours from symptom onset.
See this image and copyright information in PMC

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