Possible Neurosurgical Contribution in Treatment of Ischemic Middle Cerebral Artery (MCA) Stroke

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Possible Neurosurgical Contribution in Treatment of Ischemic Middle Cerebral Artery (MCA) Stroke

Introduction. Malignant middle cerebral artery territory infarction is the most devastating form of ischemic stroke and its treatment is still a controversial issue. Recently there has been a resurgence of interest in hemicraniectomy as a treatment tool.

Aim of study. The aim of study was to estimate potential group of patients who could be considered as a candidates for decompressive surgery.

Materials and methods. Retrospective analysis of 748 patients hospitalized in Pauls Stradins Clinical University Hospital with diagnosis of MCA stroke was performed. Patients were divided into two groups of severe and mild stroke. Groups were subdivided depending whether there was or there was no radiological and/or clinical evidence of space-occupying edema. All subgroups were analyzed in terms of mortality, cause of death.

Results. Study demonstrated higher mortality rate in group of severe MCA stroke and radiological evidence of space occupying edema was much higher in this group as well. Most of deaths in the group of severe stroke were associated with brain herniation.

Conclusion. Estimated number of patients to be considered as candidates for decompressive surgery (those who die due to fatal brain edema) in our institution is 75 per year or about 10% of all MCA strokes admitted.

References
  • Chen CC, Cho DY, Tsai SC. Outcome of and prognostic factors for decompressive hemicraniectomy in malignant middle cerebral artery infarction. J. Clin Neurosci 2007; 14:317-321.

  • Gupta R, Connoly ES, Mayer SA, Elkind MS: Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 2004, 35:539-543.

  • Hacke W. Schwab S, Horn M, Spranger M, DeGeorgia M, von Kummer R. "Malignant" middle cerebral artery territory infarction: clinical course and prognostic signs. Acta Neurol 1996; 53: 309-315.

  • Ivamoto HS, Numoto M, Donaghy RM. Surgical decompression for cerebral and cerebellar infarcts. Stroke 1974; 5:365-370.

  • Juettler E, Schwab S, Schmiedek P, et al.: Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomised, controlled trial. Stroke 2007, 38:2518-2525.

  • Xiao-feng Y, et al.: Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth? Journal of Zhejiang University SCIENCE 2005, 6B(7):644-649.

  • Mayer S: Hemicraniectomy. A second chance on life for patients with space-occupying MCA infarction. Stroke 2007, 38:2410-2412.

  • Mori K, Nakao Y, Yamamoto T, Maeda M. Early external decompressive craniectomy with duroplasty improves functional recovery in patients with massive hemispheric embolic infarction: timing and indication of decompressive surgery for malignant cerebral infarction. Surg Neurol 2004. 62: 420-430.

  • Qureshi Al, Suarez JI, Yahia AM, et al. Timing of neurologic deterioration in massive middle cerebral artery infarction: a multicentre review. Crit Care Med 2003; 31:272-277.

  • Rengachary SS, Batnitzky S, Morantz RA, Arjunan K, Jeffries B. Hemicraniectomy for acute massive cerebral infarction. Neurosurgery 1981; 8:321-328.

  • FL, Norris JW, Lewis AJ, Hachinski VC. Early mortality following stroke: a prospective review. Stroke 1984; 15:492-496.

  • Vibbert M, Mayer SA: Early decompressive hemicraniectomy following malignant ischemic stroke: the crucial role of timing. Curr Neurol Neurosci Rep 2010, 10:1-3. Silver

  • Vahedi K, Hofmeijer J, Juettler E, et al.: Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007, 6:215-222.

  • Xiao-feng Y, et al.: Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth? Journal of Zhejiang University SCIENCE 2005, 6B(7):644-649.

Acta Chirurgica Latviensis

The Journal of Riga Stradins University; Latvian Association of Surgeons; Latvian Association of Paediatric Surgeons

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