Decompressive Craniectomy in Acute Cerebral Infarction: Treatment Results and Prognostic Factors

You, Seung Hoon; Lee, Jung Il; Kim, Jong Soo; Hong, Seung Chyul

Abstract

OBJECTIVE
We investigated the treatment result and prognostic factors in patients with malignant cerebral infarction who underwent decompressive craniectomy during ongoing brain herniation. METHODS: We retrospectively reviewed the medical records and radiological findings of 31 patients who underwent decompressive craniectomy due to acute cerebral infarction. All patients showed progressive deterioration of neurological status with signs of brain stem compression at the time of surgery. Wide frontotemporoparietal craniectomy and duroplasty was done. Postoperatively, continuous intracranial pressure (ICP) monitoring and barbiturate coma therapy were performed. RESULTS: Seventeen out of thirty one patients (54.8 %) survived. At 6 months after the surgery, 14 patients recovered to Galsgow outcome scale 3 or more. Age, sex, and interval between symptom onset and operation did not affect the survival. Preoperative Glasgow coma scale (GCS) score was the only prognostic factor that was statistically significant. The mean GCS scores of the patients who survived and died were 10.1+/-3.8 and 6.6+/-2.3, respectively (p=0.002). Although the difference was not statistically significant, in patients who died, the infarct area tended to be more extensive and additionally involved basal ganglia or anterior cerebral artery (ACA) territory (p=0.157). CONCLUSION: It is suggested that the patients with massive cerebral infarction can be helped by decompressive craniectomy and aggressive intensive care even in the phase of brain stem dysfunction due to ongoing brain herniation. Preoperative GCS score is an important factor which should be considered in decision of the surgical treatment.