title: Decompressive surgery for malignant supratentorial infarction remains underutilized after guideline publication.
abstract: Decompressive surgery <48 h from stroke onset reduces the prevalence of mortality and morbidity from malignant supratentorial infarction. We investigated if utilization of decompressive surgery changed in the Czech Republic (CZ) after the release of new guidelines regarding treatment of malignant brain infarction. The volume of decompressive surgery in 2009 in all centers in the CZ was assessed using the same methodology as in 2006. All neurosurgery departments in the CZ were asked to complete a questionnaire and asked to identify all cases of decompressive surgery for malignant brain infarction through a combination of discharge codes for "brain infarction" and "decompressive surgery" from electronic hospital charts. Data for 56 patients were obtained from 15 of the 16 neurosurgery departments in the CZ. The average age was 53 ± 13; number of males 20; median time to surgery was 48 h (range 24-62); median NIHSS score was 25 (IQR, 20-30); median infarct volume was 300 cm(3) [interquartile (IQR, 250-350)]; mean shift on CT was 10.6 ± 3.6 mm and size of hemicraniectomy was 125 cm(2) (IQR, 110-154). A favorable outcome was achieved in 45% of the patients. The number of procedures increased from 39 in 2,006 to 2,056 in 2009. Based on data from one stroke center, 10% suffered from malignant supratentorial infarction and 2.3% met the criteria for decompressive surgery. In 2009, as compared to 2006, the volume of decompressive surgery carried out moderately increased. However, procedures remained underutilized because only ~10% of those who needed decompressive surgery underwent surgery.
authors: Department of Neurology, Faculty Hospital Ostrava, Tr. 17. Listopadu 1790, 708 52 Ostrava, Czech Republic. michal.bar@fno.cz
authors: Michal
authors: M
authors: Bar
authors: Robert
authors: R
authors: Mikulik
authors: David
authors: D
authors: Skoloudik
authors: Daniel
authors: D
authors: Czerny
authors: Radim
authors: R
authors: Lipina
authors: Martin
authors: M
authors: Sames
authors: Milan
authors: M
authors: Choc
authors: Zdenek
authors: Z
authors: Novak
authors: Marian
authors: M
authors: Stary
authors: Vladimir
authors: V
authors: Benes
authors: Martin
authors: M
authors: Smrcka
authors: Michal
authors: M
authors: Filip
authors: Denisa
authors: D
authors: Vondrackova
authors: Vladimir
authors: V
authors: Chlouba
authors: Petr
authors: P
authors: Suchomel
authors: Pavel
authors: P
authors: Haninec
authors: Richard
authors: R
authors: Brzezny
authors: Vilem
authors: V
authors: Juran
mesh_terms: D000328:Adult; D000368:Aged; D020520:Brain Infarction / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D018153:Czech Republic / Q000453:epidemiology; D019299:Decompression, Surgical / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data* / Q000639:trends; D017410:Practice Guidelines as Topic / Q000592:standards; D015995:Prevalence; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends