J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):175-184. 10.7461/jcen.2016.18.3.175.

Analysis of the Outcome and Prognostic Factors of Decompressive Craniectomy between Young and Elderly Patients for Acute Middle Cerebral Artery Infarction

• Yoo BR
• Yoo CJ
• Kim MJ
• Kim WK
• Choi DH

• KMID: 2355639
• DOI: http://doi.org/10.7461/jcen.2016.18.3.175

Abstract

OBJECTIVE
We compared the effect of decompressive craniectomy between patients < 65 and ≥ 65 years age and investigated prognostics factors that may help predict favorable outcome in acute stroke patients undergoing decompressive surgery.
MATERIALS AND METHODS
52 patients diagnosed with acute middle cerebral artery (MCA) territory infarction that underwent decompressive craniectomy were retrospectively reviewed. The outcome of all patients were evaluated by assessing the Glasgow coma scale, Glasgow outcome scale (GOS), and Modified Rankin scale (mRS) six months after the onset of the disease. 21 patients were preoperatively evaluated with a computed tomography angiography (CTA). Leptomeningeal collateral (LMC) circulation was graded using CTA by experienced neurosurgeons to assess its prognostic value.
RESULTS
The thirty day mortality for patients ≥ 65 was 35.0% compared to 37.5% in patients < 65. There was no significant difference in the clinical and function outcome between the two groups (4.8 ± 1.2 vs. 4.5 ± 1.5, p = 0.474). Mortality was lower with early surgery (within 24 hours) group for both age groups (25% vs. 37.5% in ≥ 65, 20% vs. 40.7% in < 65). Longer intensive care units stay time and good collateral supply score were correlated with favorable outcome (p = 0.028, p = 0.018).
CONCLUSION
Decompressive craniectomy within 24 hours of stroke symptom onset improved survival in both the < 65 and ≥ 65 age groups. There was no significant difference in the functional outcome of both age groups. Unlike previous reports, old age, delayed operation, and multiple of infarct territories were not predictive of poor functional outcome. The presence of good collateral circulation may be a predictor of positive clinical outcome in acute ischemic stroke patients undergoing decompressive craniectomy.

Keyword

Cerebral infarction; Middle cerebral artery; Craniectomy; Cerebral edema; Collateral circulation

MeSH Terms

Aged*
Angiography
Brain Edema
Cerebral Infarction
Collateral Circulation
Decompressive Craniectomy*
Glasgow Coma Scale
Glasgow Outcome Scale
Humans
Infarction
Infarction, Middle Cerebral Artery*
Intensive Care Units
Middle Cerebral Artery*
Mortality
Neurosurgeons
Retrospective Studies
Stroke

Figure

• 

  Fig. 1 Collateral supply status measured by leptomeningeal collateral grade in CTA. (A) CS = 0, (B) CS = 1, (C) CS = 2, (D) CS = 3. CTA = computed tomography angiography; CS = collateral supply.

• 

  Fig. 2 Distributions of modified Rankin scale score in patient that underwent early (≤ 24 hours) decompressive craniectomy and delayed (> 24) decompressive craniectomy.

• 

  Fig. 3 Distribution of modified Rankin scale score in decompressive craniectomy patients aged ≥ 65 and < 65.

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