Skip to main content

Advertisement

SpringerLink
Log in

Long-Term Survival After Decompressive Craniectomy for Malignant Brain Infarction: A 10-Year Nationwide Study

  • Original Work
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Decompressive craniectomy (DC) has been shown to be an effective treatment for malignant cerebral infarction (MCI). There are limited nationwide studies evaluating outcome after craniectomy for MCI.

Objective

To describe the evolution in DC practices for MCI, long-term survival, and associated prognostic factors.

Methods

We searched the French medico-administrative national database to retrieve patients who underwent DC between 2008 and 2017.

Results

A total of 1841 cases of DC were performed over 10 years in 51 centers. Mean age at procedure was 50.9 years, 18% were above 60 years, and 64.4% were male. There was a significant increase in DC for MCI over the 10 years (p < 0.001), and the annual volume of procedures more than doubled (95/year vs. 243/year). Early survival at one week and one month was 86%, 95%CI (84.5, 87.6) and 79.7%, 95%CI (77.8, 81.5), respectively. Long-term survival at 1 and 5 years were 73.6%, 95%CI (71.6, 75.7) and 68.9%, 95%CI (66.5, 71.4), respectively. Patients below 60 years at the time of DC (HR = 0.5; 95%CI [0.4, 0.7], p < 0.001), DC being performed in a center with a high surgical activity (HR = 0.8; 95%CI [0.6, 0.9], p = 0.002), and the patients having unimpaired consciousness (HR = 0.6; 95%CI [0.5, 0.8], p < 0.001) were associated with increased survival in both univariate and adjusted Cox regressions. 18.7% of the survivors had a cranioplasty inserted within 3 months and 57.8% within 6 months. The probability of having a cranioplasty at one year was 75.6%, 95%CI (77.9, 73.1).

Conclusion

Over the past 10 years in France, DC has been increasingly performed for MCI regardless of age. However, in-hospital mortality remains considerable, as about one quarter of patients died within the first weeks. For those who survive beyond 6 months, the risk of death significantly decreases. Early mortality is especially high for comatose patients above 60 years operated in inexperienced centers. Most of those who remain in good functional status tend to undergo a cranioplasty within the year following DC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CCAM:

Common classification of medical acts

CI:

Confidence interval

DC:

Decompressive craniectomy

GCS:

Glasgow Coma Scale

HDH:

Health data hub

HR:

Hazard ratio

IQR:

Interquartile range

IS:

Ischemic stroke

MCA:

Middle cerebral artery

MCI:

Malignant cerebral infarction

mRS:

Modified Rankin scale

PMSI:

Programme de médicalisation des systèmes d’information

OS:

Overall survival

SNDS:

Système national des données de santé

WHO:

World Health Organization

References

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

    Article  CAS  Google Scholar 

  2. Vahedi K, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007;38:2506–17.

    Article  Google Scholar 

  3. Mohan Rajwani K, Crocker M, Moynihan B. Decompressive craniectomy for the treatment of malignant middle cerebral artery infarction. Br J Neurosurg. 2017;31:401–9.

    Article  Google Scholar 

  4. Li Y-P, et al. Neurologic functional outcomes of decompressive hemicraniectomy versus conventional treatment for malignant middle cerebral artery infarction: a systematic review and meta-analysis. World Neurosurg. 2017;99:709–725.e3.

    Article  Google Scholar 

  5. Streib CD, Hartman LM, Molyneaux BJ. Early decompressive craniectomy for malignant cerebral infarction: meta-analysis and clinical decision algorithm. Neurol Clin Pract. 2016;6:433–43.

    Article  Google Scholar 

  6. Vahedi K, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–22.

    Article  Google Scholar 

  7. Geurts M, et al. Surgical decompression for space-occupying cerebral infarction: outcomes at 3 years in the randomized HAMLET trial. Stroke. 2013;44:2506–8.

    Article  Google Scholar 

  8. Jüttler E, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. New Engl J Med. 2014;370:1091–100.

    Article  Google Scholar 

  9. Pfefferkorn T, et al. Long-term outcome after suboccipital decompressive craniectomy for malignant cerebellar infarction. Stroke. 2009;40:3045–50.

    Article  Google Scholar 

  10. Ayling OGS, et al. Suboccipital decompressive craniectomy for cerebellar infarction: a systematic review and meta-analysis. World Neurosurg. 2018;110:450–459.e5.

    Article  Google Scholar 

  11. Basu P, Jenkins H, Tsang K, Vakharia VN. National survey of neurosurgeons and stroke physicians on decompressive hemicraniectomy for malignant middle cerebral artery infarction. World Neurosurg. 2017;102:320–8.

    Article  Google Scholar 

  12. Gopalakrishnan MS, et al. Complications of decompressive craniectomy. Front Neurol. 2018;9:977.

    Article  CAS  Google Scholar 

  13. Li A, et al. Cranioplasty complications and costs: a national population-level analysis using the MarketScan longitudinal database. World Neurosurg. 2017;102:209–20.

    Article  Google Scholar 

  14. Champeaux C, Weller J, Katsahian S. Epidemiology of meningiomas. A nationwide study of surgically treated tumours on French medico-administrative data. Cancer Epidemiol. 2018;58:63–70.

    Article  Google Scholar 

  15. Giroud M, et al. Positive predictive value of French hospitalization discharge codes for stroke and transient ischemic attack. Eur Neurol. 2015;74:92–9.

    Article  Google Scholar 

  16. Harrell FE Jr. Regression modeling strategies. New York: Springer; 2015.

    Book  Google Scholar 

  17. Therneau TM, Grambsch PM. Modeling survival data: extending the cox model. Berlin: Springer; 2000.

    Book  Google Scholar 

  18. R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing; 2014. http://www.R-project.org/.

  19. Therneau TM. A package for survival analysis in s; 2015. http://CRAN.R-project.org/package=survival.

  20. RStudio Team. RStudio: integrated development environment for r. RStudio, Inc.; 2015. http://www.rstudio.com/.

  21. Nicholls SG, et al. The REporting of studies conducted using observational routinely-collected health data (RECORD) statement: methods for arriving at consensus and developing reporting guidelines. PLoS ONE. 2015;10:e0125620.

    Article  Google Scholar 

  22. Lang TA, Altman DG. Basic statistical reporting for articles published in biomedical journals: the “statistical analyses and methods in the published literature” or the SAMPL Guidelines. Int J Nurs Stud. 2015;52:5–9.

    Article  Google Scholar 

  23. Schmidt A, Heroum C, Caumette D, Le Lay K, Bénard S. Acute Ischemic Stroke (AIS) patient management in French stroke units and impact estimation of thrombolysis on care pathways and associated costs. Cerebrovasc Dis (Basel, Switzerland). 2015;39:94–101.

    Article  Google Scholar 

  24. Moulis G, et al. French health insurance databases: what interest for medical research? Rev Med Interne. 2015;36:411–7.

    Article  CAS  Google Scholar 

  25. Roussot A, et al. The use of national administrative data to describe the spatial distribution of in-hospital mortality following stroke in France, 2008–2011. Int J Health Geograph. 2016;15:2.

    Article  Google Scholar 

  26. Lecoffre C, et al. National trends in patients hospitalized for stroke and stroke mortality in France, 2008 to 2014. Stroke. 2017;48:2939–45.

    Article  Google Scholar 

  27. Adeoye O, Hornung R, Khatri P, Ringer A, Kleindorfer D. The rate of hemicraniectomy for acute ischemic stroke is increasing in the United States. J Stroke Cerebrovasc Dis: Off J Natl Stroke Assoc. 2011;20:251–4.

    Article  Google Scholar 

  28. Walcott BP, et al. Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals. PLoS ONE. 2011;6:e29193.

    Article  CAS  Google Scholar 

  29. Suyama K, Horie N, Hayashi K, Nagata I. Nationwide survey of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Japan. World Neurosurg. 2014;82:1158–63.

    Article  Google Scholar 

  30. Dasenbrock HH, et al. Patient age and the outcomes after decompressive hemicraniectomy for stroke: a nationwide inpatient sample analysis. Neurocrit Care. 2016;25:371–83.

    Article  Google Scholar 

  31. Peter A, Birgitta S, Andreas Terént. Sex Differences in Stroke Epidemiology. Stroke. 2009;40:1082–90.

    Google Scholar 

  32. Stefan S, Bo N, Jesper Petersson, Teresa Ullberg. Long-term survival and function after stroke. Stroke. 2019;50:53–61.

    Article  Google Scholar 

  33. Rejnö Å, Nasic S, Bjälkefur K, Bertholds E, Jood K. Changes in functional outcome over five years after stroke. Brain Behav. 2019. https://doi.org/10.1002/brb3.1300.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wolfe CDA, et al. Estimates of outcomes up to ten years after stroke: analysis from the prospective south London stroke register. PLoS Med. 2011;8:e1001033.

    Article  Google Scholar 

  35. de Campos LM, et al. How many patients become functionally dependent after a stroke? A 3-year population-based study in Joinville, Brazil. PLoS ONE. 2017;12:e0170204.

    Article  Google Scholar 

  36. Gul W, Fuller HR, Wright H, Sen J. A systematic review and meta-analysis of the effectiveness of surgical decompression in treating patients with malignant middle cerebral artery infarction. World Neurosurg. 2018;120:e902–20.

    Article  Google Scholar 

  37. Dasenbrock HH, et al. Timing of decompressive hemicraniectomy for stroke: a nationwide inpatient sample analysis. Stroke. 2017;48:704–11.

    Article  Google Scholar 

  38. Borger V, Schuss P, Kinfe TM, Vatter H, Güresir E. Decompressive craniectomy for stroke: early cranioplasty is a predictor for postoperative complications. World Neurosurg. 2016;92:83–8.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Rebecca Grant for her review of the manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Charles Champeaux and Joconde Weller have contributed equally to this work.

Authors and Affiliations

  1. INSERM U1153, Statistic and Epidemiologic Research Centre Sorbonne Paris Cité (CRESS), ECSTRA Team, Université Diderot - Paris 7, USPC, Paris, France

    Charles Champeaux

  2. Department of Neurosurgery, Lariboisière Hospital, 75010, Paris, France

    Charles Champeaux

  3. Department of Medical Information, Sainte-Anne Hospital, 75014, Paris, France

    Joconde Weller

  4. Department of Neurosurgery, Lariboisière Hospital, 2, rue Ambroise Paré, 75475, Paris Cedex 10, France

    Charles Champeaux

Authors
  1. Charles Champeaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joconde Weller
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CC Conceived and designed the analysis/ Performed the analysis/ Draft the manuscript/ Revision of the work. JW Conceived and designed the analysis/ Collected the data/ Performed the analysis/ Revision of the work.

Corresponding author

Correspondence to Charles Champeaux.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Ethical Approval

This study was approved by French data protection authority (CNIL), an independent national ethical committee, authorisation number: 2213957v0.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Champeaux, C., Weller, J. Long-Term Survival After Decompressive Craniectomy for Malignant Brain Infarction: A 10-Year Nationwide Study. Neurocrit Care 32, 522–531 (2020). https://doi.org/10.1007/s12028-019-00774-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-019-00774-9

Keywords

Search

Navigation