Skip to main content

Advertisement

SpringerLink
Log in

Predictors of early in-hospital death after decompressive craniectomy in swollen middle cerebral artery infarction

  • Original Article - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

The present study identified additional territory infarction as a significant predictor of early in-hospital death. The relatively small sample size precludes firm conclusions.

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

Similar content being viewed by others

References

  1. Berrouschot J, Sterker M, Bettin S, Koster J, Schneider D (1998) Mortality of space-occupying (‘malignant’) middle cerebral artery infarction under conservative intensive care. Intensive Care Med 24:620–623

    Article  CAS  PubMed  Google Scholar 

  2. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Spilker J, Holleran R, Eberle R, Hertzberg V, Rorick M, Moomaw C, Wlaker M (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870

    Article  CAS  PubMed  Google Scholar 

  3. Chen CC, Cho DY, Tsai SC (2007) Outcome and prognostic factors of decompressive hemicraniectomy in malignant middle cerebral artery infarction. J Chin Med Assoc 70:56–60

    Article  PubMed  Google Scholar 

  4. Coyle P, Heistad DD (1987) Blood flow through cerebral collateral vessels one month after middle cerebral artery occlusion. Stroke 18:407–411

    Article  CAS  PubMed  Google Scholar 

  5. Daou B, Kent AP, Montano M, Chalouhi N, Starke RM, Tjoumakaris S, Rosenwasser RH, Jabbour P (2016) Decompressive hemicraniectomy: predictors of functional outcome in patients with ischemic stroke. J Neurosurg 124:1773–1779

    Article  PubMed  Google Scholar 

  6. Frank JI (1995) Large hemispheric infarction, deterioration, and intracranial pressure. Neurology 45:1286–1290

    Article  CAS  PubMed  Google Scholar 

  7. Frank JI, Schumm LP, Wroblewski K, Chyatte D, Rosengart AJ, Kordeck C, Thisted RA, HeADDRIRST Trialists (2014) Hemicraniectomy and Durotomy Upon Deterioration From Infarction-Related Swelling Trial: Randomized Pilot Clinical Trial. Stroke 45:781–787

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gupta R, Connolly ES, Mayer S, Elkind MS (2004) Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 35:539–543

    Article  PubMed  Google Scholar 

  9. Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996) ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53:309–315

    Article  CAS  PubMed  Google Scholar 

  10. Harscher S, Reichart R, Terborg C, Hagemann G, Kalff R, Witte OW (2006) Outcome after decompressive craniectomy in patients with severe ischemic stroke. Acta Neurochir (Wien) 148:31–37

    Article  CAS  Google Scholar 

  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 8:326–333

    Article  PubMed  Google Scholar 

  12. Holtkamp M, Buchheim K, Unterberg A, Hoffmann O, Schielke E, Weber JR, Masuhr F (2001) Hemicraniectomy in elderly patients with space occupying media infarction: improved survival but poor functional outcome. J Neurol Neurosurg Psychiatry 70:226–228

    Article  CAS  PubMed  PubMed Central  Google 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 38:2518–2525

    Article  PubMed  Google Scholar 

  14. Kim H, Jin ST, Kim YW, Kim SR, Park IS, Jo KW (2015) Predictors of malignant brain edema in middle cerebral artery infarction observed on CT angiography. J Clin Neurosci 22:554–560

    Article  PubMed  Google Scholar 

  15. Lam WW, Leung TW, Chu WC, Yeung DT, Wong LK, Poon WS (2005) Early computed tomography features in extensive middle cerebral artery territory infarct: prediction of survival. J Neurol Neurosurg Psychiatry 76:354–357

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lorente L, Martin MM, Abreu-Gonzalez P, Ramos L, Argueso M, Solé-Violán J, Jiménez A (2015) Serum malondialdehyde levels in patients with malignant middle cerebral artery infarction are associated with mortality. PLoS One 10:e0125893

    Article  PubMed  PubMed Central  Google 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 113:25–30

    Article  CAS  PubMed  Google Scholar 

  18. McKenna A, Wilson CF, Caldwell SB, Curran D (2012) Functional outcomes of decompressive hemicraniectomy following malignant middle cerebral artery infarctions: a systematic review. Br J Neurosurg 26:310–315

    Article  PubMed  Google Scholar 

  19. Rieke K, Schwab S, Krieger D, von Kummer R, Aschoff A, Schuchardt V, Hacke W (1995) Decompressive surgery in space-occupying hemispheric infarction: results of an open, prospective trial. Crit Care Med 23:1576–1587

    Article  CAS  PubMed  Google Scholar 

  20. Ropper AH (1986) Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass. N Engl J Med 314:953–958

    Article  CAS  PubMed  Google Scholar 

  21. Sakai K, Iwahashi K, Terada K, Gohda Y, Sakurai M, Matsumoto Y (1998) Outcome after external decompression for massive cerebral infarction. Neurol Med Chir (Tokyo) 38:131–135

    Article  CAS  Google Scholar 

  22. Scarcella G (1956) Encephalomalacia simulating the clinical and radiological aspects of brain tumor; a report of 6 cases. J Neurosurg 13:278–292

    Article  CAS  PubMed  Google Scholar 

  23. Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W (1998) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29:1888–1893

    Article  CAS  PubMed  Google Scholar 

  24. Shaw CM, Alvord EC Jr, Berry RG (1959) Swelling of the brain following ischemic infarction with arterial occlusion. Arch Neurol 1:161–177

    Article  CAS  PubMed  Google Scholar 

  25. Steyerberg E (2009) Clinical prediction models, a practical approach to development, validation and updating. Springer

  26. Sundseth J, Sundseth A, Thommessen B, Johnsen LG, Altmann M, Sorteberg W, Lindegaard KF, Berg-Johnsen J (2015) Long-term outcome and quality of life after craniectomy in speech-dominant swollen middle cerebral artery infarction. Neurocrit Care 22:6–14

    Article  PubMed  Google Scholar 

  27. Suyama K, Horie N, Hayashi K, Nagata I (2014) Nationwide survey of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Japan. World Neurosurg 82:1158–1163

    Article  PubMed  Google Scholar 

  28. Tu PH, Liu ZH, Chuang CC, Yang TC, Wu CT, Lee ST (2012) Postoperative midline shift as secondary screening for the long-term outcomes of surgical decompression of malignant middle cerebral artery infarcts. J Clin Neurosci 19:661–664

    Article  PubMed  Google 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 6:215–222

    Article  PubMed  Google 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 38:2506–2517

    Article  PubMed  Google Scholar 

  31. Wagner S, Schnippering H, Aschoff A, Koziol JA, Schwab S, Steiner T (2001) Suboptimum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery. J Neurosurg 94:693–696

    Article  CAS  PubMed  Google Scholar 

  32. Walcott BP, Miller JC, Kwon CS, Sheth SA, Hiller M, Cronin CA, Schwamm LH, Simard JM, Kahle KT, Kimberly WT, Sheth KN (2014) Outcomes in severe middle cerebral artery ischemic stroke. Neurocrit Care 21:20–26

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yu JW, Choi JH, Kim DH, Cha JK, Huh JT (2012) Outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 70 years old. J Cerebrovasc Endovasc Neurosurg 14:65–74

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank all patients and their close relatives for their benevolent participation.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway

    Jarle Sundseth, Wilhelm Sorteberg, Karl-Fredrik Lindegaard & Jon Berg-Johnsen

  2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

    Antje Sundseth, Karl-Fredrik Lindegaard & Jon Berg-Johnsen

  3. Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway

    Antje Sundseth, Marianne Altmann & Bente Thommessen

  4. Department of Radiology, Oslo University Hospital Rikshospitalet, Oslo, Norway

    Eva Astrid Jacobsen

  5. Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway

    Are Hugo Pripp

Authors
  1. Jarle Sundseth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antje Sundseth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eva Astrid Jacobsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Are Hugo Pripp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wilhelm Sorteberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marianne Altmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karl-Fredrik Lindegaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jon Berg-Johnsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bente Thommessen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jarle Sundseth.

Ethics declarations

Funding

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

None.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study, their close relatives or legal guardians.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sundseth, J., Sundseth, A., Jacobsen, E.A. et al. Predictors of early in-hospital death after decompressive craniectomy in swollen middle cerebral artery infarction. Acta Neurochir 159, 301–306 (2017). https://doi.org/10.1007/s00701-016-3049-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-016-3049-0

Keywords

Search

Navigation