Outcome and prognostic factors of hemicraniectomy for space occupying cerebral infarction.
OBJECTIVE
To determine long term functional outcome and length of survival of patients undergoing decompressive craniectomy for space occupying infarction of the middle cerebral artery (MCA), and to identify risk factors associated with death and unfavourable outcomes


METHODS
Databases of patients undergoing decompressive craniectomy for space occupying MCA infarction compiled at eight neurosurgical departments (1996-2001) were merged, and 188 patients were evaluated. Mortality was calculated by the Kaplan-Meier method. Clinical outcome was rated using the Glasgow outcome scale (GOS). The prognostic impact of patient related covariates on length of survival and the GOS was analysed multivariately.


RESULTS
The unadjusted 3, 6, and 12 month mortality rates were 7.9%, 37.6%, and 43.8%, respectively (median follow up, 26 weeks). In the "best" multivariate model, age >50 years (p<0.02) and the involvement of two or more additional vascular territories (p<0.01) had an unfavourable impact on length of survival. The adjusted six month mortality was as low as 20.0% (no risk factor) and as high as 59.7% (two risk factors). A GOS score of <or=3 was significantly associated with age >50 years (p<0.0003): 34.9% of the patients <or=50 years of age achieved a GOS score of >3, as compared with 12.0% of the elderly subpopulation. The side of the infarct did not have prognostic relevance.


CONCLUSIONS
Results of surgical treatment in patients <50 years of age undergoing decompressive craniectomy are encouraging. The effectiveness of decompressive craniectomy for patients >50 years remains questionable and should be analysed in the framework of a prospective randomised study.
Uhl
E
E
Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany. euhl@nc.med.uni-muenchen.de
Kreth
F W
FW
Elias
B
B
Goldammer
A
A
Hempelmann
R G
RG
Liefner
M
M
Nowak
G
G
Oertel
M
M
Schmieder
K
K
Schneider
G-H
GH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D007839:Functional Laterality; D023261:Glasgow Outcome Scale; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors