Predictors of early in-hospital death after decompressive craniectomy in swollen middle cerebral artery infarction
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Swollen middle cerebral artery infarction is a life-threatening disease and decompressive craniectomy is improving survival significantly. Despite decompressive surgery, however, many patients are not discharged from the hospital alive. We therefore wanted to search for predictors of early in-hospital death after craniectomy in swollen middle cerebral artery infarction.
All patients operated with decompressive craniectomy due to swollen middle cerebral artery infarction at the Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway, between May 1998 and October 2010, were included. Binary logistic regression analyses were performed and candidate variables were age, sex, time from stroke onset to decompressive craniectomy, NIHSS on admission, infarction territory, pineal gland displacement, reduction of pineal gland displacement after surgery, and craniectomy size.
Fourteen out of 45 patients (31%) died during the primary hospitalization (range, 3–44 days). In the multivariate logistic regression model, middle cerebral artery infarction with additional anterior and/or posterior cerebral artery territory involvement was found as the only significant predictor of early in-hospital death (OR, 12.7; 95% CI, 0.01–0.77; p = 0.029).
The present study identified additional territory infarction as a significant predictor of early in-hospital death. The relatively small sample size precludes firm conclusions.
KeywordsDecompressive craniectomy Swollen Middle cerebral artery infarction Predictors Outcome
We thank all patients and their close relatives for their benevolent participation.
Compliance with ethical standards
Gidske and Peder Jacob Sørensens’ research foundation provided financial support for the study to be completed. The sponsor had no role in the design or conduct of this research.
Conflict of interest
All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study, their close relatives or legal guardians.
- 11.Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB (2009) Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 8:326–333CrossRefPubMedGoogle Scholar
- 13.Jüttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, Woitzik J, Witte S, Jenetzky E, Hacke W, DESTINY Study Group (2007) Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 38:2518–2525CrossRefPubMedGoogle Scholar
- 17.Malm J, Bergenheim AT, Enblad P, Hårdemark HG, Koskinen LO, Naredi S, Nordstrøm CH, Norrving B, Uhlin J, Lindgren A (2006) The Swedish Malignant Middle cerebral artery Infarction Study: long-term results from a prospective study of hemicraniectomy combined with standardized neurointensive care. Acta Neurol Scand 113:25–30CrossRefPubMedGoogle Scholar
- 25.Steyerberg E (2009) Clinical prediction models, a practical approach to development, validation and updating. SpringerGoogle Scholar
- 29.Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, Hacke W, DECIMAL, DESTINY and HAMLET investigators (2007) Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6:215–222CrossRefPubMedGoogle Scholar
- 30.Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, Boutron C, Couvreur G, Rouanet F, Touzé E, Guillon B, Carpentier A, Yelnik A, George B, Payen D, Bousser MG, DECIMAL investigators (2007) Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 38:2506–2517CrossRefPubMedGoogle Scholar