The Swedish Malignant Middle cerebral artery Infarction Study : long-term results from a prospective study of hemicraniectomy combined with standardized neurointensive care

• Objectives: Hemicraniectomy in patients with malignant middle cerebral artery (mMCA) infarct may be life-saving. The long-term prognosis is unknown.Methods: Patients with mMCA infarct treated with hemicraniectomy between 1998 and 2002 at three hospitals were included. The criterion for surgical intervention was if the patients deteriorated from awake to being responding to painful stimuli only. All patients were followed for at least 1 year. Outcome was defined as alive/dead, walkers/non-walkers or modified Rankin Scale (mRS) score ≤2.Results: Thirty patients were included (median age at stroke onset 49 years, range 17–67 years). Fourteen patients had mMCA infarct on the left side and 16 patients on the right side. Fourteen patients had pupil dilatation before surgery. Hemicraniectomy was performed at a median of 52 h (range 13–235 h) after stroke onset. Nine patients died within 1 month after surgery because of cerebral herniation (n = 6), myocardial infarction (n = 1) or intensive care complications (n = 2). No further deaths occurred during follow-up, which was at median 3.4 years after surgery. Status for the 21 survivors at the last follow-up was: mRS 2 or less (n = 6) and mRS 3–5 (n = 15). The oldest patient with mRS 2 or less was 53 years at stroke onset. Thirteen patients (43%) could walk without substantial aid.Conclusion:  The long-term survival after mMCA infarction treated with hemicraniectomy seems to be favourable if the patient survives the acute phase. The outcome as measured with mRS may be better among younger patients.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

Nyckelord

Acute Disease

Adolescent

Adult

Aged

Combined Modality Therapy

Craniotomy

Decompression; Surgical

Disability Evaluation

Female

Follow-Up Studies

Humans

Infarction; Middle Cerebral Artery/mortality/*surgery/*therapy

Intensive Care

Male

Middle Aged

Postoperative Care

Prognosis

Prospective Studies

Survival Rate

Sweden

Time Factors

intracranial pressure

cerebral infarction

brain oedema

prognosis

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)