Publication year: 2011
Source: World Neurosurgery, Available online 24 December 2011
Dean B. Kostov, Richard H. Singleton, David Panczykowski, Hilal A. Kanaan, Michael B. Horowitz, ...
ObjectiveWe sought to evaluate the impact of acraniotomy forstrokectomy (CS) with bone replacement,decompressivehemicraniectomy (DHC), or DHC with astrokectomy (DHC+S) on outcome after malignant supratentorial infarction.MethodsWe conducted a retrospective cohort study of cases of malignant supratentorial infarction treated by CS (n=18), DHC (n=17), or DHC+S (n=33) at our institution from 2002-2008. End-points included functional outcome measured by the modified Rankin Scale (mRS) and incidence of mortality at 1 year.ResultsMean age, gender, side, vessel, and time from ictus to surgery were not statistically different between treatment groups. Stroke volume was significantly higher in the CS group. Operative time and blood loss were significantly higher in the DHC+S group. At one year, the median mRS was 4 and overall survival was 71%. Functional outcomes and mortality for both the CS and DHC+S groups were not significantly different from the DHC group (p=0.24). After adjusting for patient age, stroke volume, and time to surgery, there was no significant difference in outcome.ConclusionIn patients with malignant supratentorial infarction, a strokectomy alone may be equivalent to a decompressive hemicraniectomy with or without brain resection.
Júlio Leonardo B. Pereira
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