Decompressive surgery in space-occupying hemispheric infarction: results of an open, prospective trial.
OBJECTIVE
Space-occupying hemispheric infarctions, requiring neurocritical care treatment, demonstrate high mortality and morbidity rates. This study was performed to determine the beneficial effects of decompressive craniotomy on mortality and morbidity rates.


METHODS
Open, nonrandomized, control trial. Outcome was rated at discharge from the hospital (Glasgow Outcome Scale) and at follow-up (Barthel Index, Oxford Handicap Scale).


METHODS
Patient recruitment from the Department of Neurology, University of Heidelberg (primary care center) over 65 months.


METHODS
Thirty-two patients were prospectively selected for surgical treatment; 21 patients were treated conservatively.


METHODS
Extended craniotomy and dura patch enlargement were performed in all surgically treated patients.


RESULTS
At discharge, the outcome of six (18.8%) of 32 surgically treated patients was good compared with 0 (0%) of 21 conservatively treated patients. Fifteen (46.9%) of 32 surgically treated patients were moderately to severely disabled compared with five (23.8%) of 21 conservatively treated patients, and 11 (34.4%) of 32 surgically treated patients died compared with 16 (76.2%) of 21 conservatively treated patients. At follow-up in surgically treated patients, the Barthel Index (mean 62.6) showed an excellent level of daily activity in one patient, minimal assistance (Barthel Index of > or = 60) in 15 patients, and dependency in five patients. The Oxford Handicap Scale indicated no handicap in one patient, moderate handicaps in 15 patients, and moderately severe handicaps in five patients. In the control group, all five surviving patients needed assistance and all but one patient demonstrated a moderately severe handicap.


CONCLUSIONS
Hemicraniotomy may improve survival in massive hemispheric stroke victims, decreasing mortality rates to < 35%. The disability rate remains high (24%), although some patients seem to benefit significantly.
Rieke
K
K
Department of Neurology, University of Heidelberg, FRG.
Schwab
S
S
Krieger
D
D
von Kummer
R
R
Aschoff
A
A
Schuchardt
V
V
Hacke
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D003399:Craniotomy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome