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September2004 Vol.41 Issue:        3       (Supp.) Table of Contents
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Decompressive Hemicraniectomy for Management of Massive Middle Cerebral Artery Territory Infarction: Pharmacological, Perioperative and Anesthetic Techniques

Hatem Samir1, Mohammad Farouk Youssef2, Ayman Enab3

 

Departments of Neurology1, Anesthesia2, Neurosurgery3, Cairo University



ABSTRACT

Background and Purpose: Massive, space-occupying middle cerebral artery infarct is a life-threatening vascular event with unsatisfactory therapeutic options. Despite full supportive care in the intensive care unit and traditional forms of therapy for cerebral edema, the mortality rate due to cerebral herniation remains very high. Our objective is to determine the beneficial effects of decompressive hemicraniectomy on mortality and morbidity rates in those patients. Methods: In this prospective study, hemicraniectomy was performed in eleven Egyptian patients with acute complete middle cerebral artery infarction after optimum medical management; surgical intervention was done whenever the first signs of herniation had occurred. Initial clinical presentation was assessed by the National Institute of Health Stroke Scale (NIHSS), and the Glasgow Coma Scale (GCS). All survivors were reexamined 3 months after surgical decompression, with the clinical evaluation graded according to Barthel Index (BI). Results: The mean age of included patients was 52.54 + 6.5 years, 45.45% of them were under 50 years of age. The mean duration of conservative therapy was 60 + 20.78 hours. We recorded 18.18% mortality rate, with a 44.44% at least one of non-fatal post-operative complications. There was an improvement of neurological status on NIHSS post-operatively when compared with that pre-operatively. At 3 months follow up, the mean Barthel Index for the survived patients was 60, and among the patients with dominant hemisphere stroke, the speech function improved in most. A statistically significant improvement on NIHSS score post-operatively and a significantly higher BI score were detected in younger age group. Conclusions: Our study provides evidence that hemicraniectomy as a second line treatment after optimum medical therapy of malignant MCA stroke decreases mortality rate and results in a more favorable outcome, especially in younger age group.

(Egypt J. Neurol. Psychiat. Neurosurg., 2004, 41 (3) suppl.: 913-924).

 





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