RETROSPECTIVE STUDY OF DECOMPRESSIVE CRANIECTOMY IN THE TREATMENT OF MALIGNANT BRAIN EDEMA

Authors

  • M.V. SĂCELEANU “Lucian Blaga” University, Sibiu, Romania
  • A.A. MARINESCU “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • A. BALAȘA “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Târgu Mureș
  • Andreea GAVRILEI Emergency County Hospital, Sibiu, Romania
  • A.V. CIUREA “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Keywords:

ISCHEMIC STROKE, MALIGNANT BRAIN EDEMA, CRANIECTOMY, NEURO-SURGERY

Abstract

The aim of this paper is to study the evolution of patients with MCA stroke who developed MBE during hospitalization and underwent decompressive craniectomy after a failed conservative treatment. Material and methods: This is a retrospective a single-center study of 20 patients with malignant brain edema following an ischemic stroke who were surgically managed with decompressive craniectomy at Sibiu County Emergency Hospital between January 1st, 2015 and April 30th, 2019. Results: The sample was comprised of 7 women (35%) and 13 men (65%). 7 patients (35%) were under 60 years old and 13 (65%) were over 60 years old. We observed the three highest-ranking risk factors are: high blood pressure (20 patients - 100%), males and elderly both represented an equal risk category (13 patients-65%) and smoking (12 patients-60%). No patient had any surgery-related complications: 4 patients (20%) had bronchopneumonia, 1 patient (5%) had pneumonia, 1 patient (5%) had a urinary tract infection and 11 patients (55%) had irreversible cardiorespiratory arrest. At discharge, 9 patients (45%) had an ameliorated state and 11 patients (55%)died. Conclusions: Decompressive craniectomy is not a panacea and it is well known that patients will not return to the state before the pathology. It is unanimously accepted that patients who undergo surgery have a higher chance of life even if, in some patients, the quality of life is low.

Author Biographies

  • M.V. SĂCELEANU, “Lucian Blaga” University, Sibiu, Romania

    “Victor Papilian” Faculty of Medicine,
    Department of Neurosurgery
    Emergency County Hospital, Sibiu, Romania,
    Department of Neurosurgery

  • Andreea GAVRILEI, Emergency County Hospital, Sibiu, Romania

    Department of Neurosurgery

  • A.V. CIUREA, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    “Sanador” Clinical Hospital, Bucharest, Romania
    Department of Neurosurgery

References

1. Ryoo JW, Na DG, Kim SS, et al. Malignant middle cerebral artery infarction in hyperacute ischemic stroke: evaluation with multiphasic perfusion computed tomography maps. J Comput Assist Tomogr 2004; 28: 55-62.
2. Roger VL, Go AS, Lloyd-Jones DM, et al, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation 2011; 123: e18-e20.
3. Feigin VL, Forouzanfar MH, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 2014; 383: 245-254.
4. Béjot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century.PresseMed, 2016; 45(12Pt2): 391-398.
5. Jo K, Bajgur SS, Kim H, Choi HA, Huh PW, Lee K. A simple prediction score system for malignant brain edema progression in large hemispheric infarction. PLoS One 2017; 12(2): e0171425.
6. Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presen-tation, medical care, and outcomes. Lancet Neurol 2008; 7(10): 915-926.
7. Shah RS, Cole JW. Smoking and stroke: the more you smoke the more you stroke. Expert Rev Cardi-ovasc Ther 2010; 8(7): 917-932.
8. Chen CJ, Brown WM, Moomaw CJ, et al. Alcohol use and risk of intracerebral hemorrhage. Neurol-ogy 2017; 88(21): 2043-2051.
9. Hörnsten C, Weidung B, Littbrand H, et al. High blood pressure as a risk factor for incident stroke among very old people: a population-based cohort study. J Hypertens 2016; 34(10): 2059-2065.
10. Kamel H, Okin PM, Elkind MS, Iadecola C. Atrial Fibrillation and Mechanisms of Stroke: Time for a New Model. Stroke 2016; 47(3): 895-900.
11. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, et al. The DECIMAL, DESTINY, and HAMLET investigators. Early decompressive surgery in malignant middle cerebral artery infarc-tion: pooled analysis of three randomized controlled trials. Lancet Neurol 2007; 6: 215-222.
12. Juntler E, Schwab S, Schmiedek P, et al. Decompressive Surgery for the Treatment of Malignant Infarctation of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 2007; 38: 2518-2525;
13. Jutler E, Unterberg A,Woitzik J, et al. Hemicraniectomy in older patients with Extensive Middle-Cerebral Artery Stroke.N Engl J Med 2014; 370: 1091-1100.

Additional Files

Published

2020-06-30

Issue

Vol. 124 No. 2 (2020): The Medical-Surgical Journal

Section

SURGERY

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