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2016 ; 18
(3
): 175-184
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Analysis of the Outcome and Prognostic Factors of Decompressive Craniectomy
between Young and Elderly Patients for Acute Middle Cerebral Artery Infarction
#MMPMID27847759
Yoo BR
; Yoo CJ
; Kim MJ
; Kim WK
; Choi DH
J Cerebrovasc Endovasc Neurosurg
2016[Sep]; 18
(3
): 175-184
PMID27847759
show ga
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.