Decompressive craniotomy after middle cerebral artery infarction. Retrospective analysis of patients treated in three centres in Switzerland

Swiss Medical Weekly
Javier FandinoRolf W Seiler

Abstract

Several studies have reported an improved outcome in patients presenting with complete middle cerebral artery (MCA) infarction treated by decompressive hemicraniectomy. Although this palliative treatment form has gained popularity in Switzerland since 2000, the results of these series have not been reported. The aim of this study is, firstly, to report factors influencing the outcome of our patients, in order to create awareness of the indications and decision-making processes in our departments, and, secondly, to analyse therapeutic strategies which are open to improvement and standardisation. This retrospective study included a total of 28 patients (age 51 +/- 12 years) who underwent decompressive craniectomy after MCA between January 2000 and May 2002 at the Departments of Neurosurgery of Aarau (n: 6), Bern (n: 10), and Zurich (n: 12). Demographic characteristics included preoperative clinical condition (NIHSS and GCS), timing of surgery, cause, location, and extension of infarction. Additionally, the time delay from the onset of symptoms to surgery and preoperative signs of herniation and their relation to final outcome was analysed. The final outcome was assessed in terms of mortality and scores such as modified Rankin sca...Continue Reading

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