title: Decompressive craniectomy for hemispheric infarction: predictive factors for six month rehabilitation outcome.
abstract: BACKGROUND
  Decompressive craniectomy after hemispheric infarction has been shown to reduce mortality and functional outcome in selected patients. However, the optimal timing for surgery and patient most likely to benefit from this procedures was not known. We aimed to determine possible factors predictive of outcome following decompressive craniectomy for ischemic infarction from review of oneurological outcome in our patients at six months.
  
  
  METHODS
  We retrospectively reviewed 21 patients who underwent decompressive craniectomy for hemispheric infarction over a three year period in a regional neurosurgical center in Hong Kong. All patients were recruited subsequently for active in-patient rehabilitation, when suitable.
  
  
  RESULTS
  The median age was 53 and the male to female ration was 1:3. Four patients (19%) achieved independent activity of daily living at six months after rehabilitation. Neither early surgery, within 24-48 hours after admission, nor side of infarction correlated with six month neurological outcome. All four patients with favourable neurological outcome at six month demonstrated favourable clinical improvement even at one month.
  
  
  CONCLUSIONS
  Early decompressive hemicraniectomy is not predictive of neurological outcome, determined by Glasgow outcome score, at six months (P = 1.00, NS).
authors.affiliation: Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. georgewong@surgery.cuhk.edu.hk
authors.forename: G K
authors.initials: GK
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Kung
authors.forename: S C
authors.initials: SC
authors.lastname: Ng
authors.forename: X L
authors.initials: XL
authors.lastname: Zhu
authors.forename: W S
authors.initials: WS
authors.lastname: Poon
mesh_terms: D000328:Adult; D020520:Brain Infarction / Q000534:rehabilitation* / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome