title: Decompressive hemicraniectomy for malignant hemispheric stroke in the elderly: comparison of outcomes between individuals 61-70 and >70 years of age.
abstract: BACKGROUND
  Malignant hemispheric infarction is a life-threatening condition with a high mortality rate. Decompressive hemicraniectomy (DHC) is frequently a life-saving procedure that has shown the highest grade of evidence for patients 18 to 60 years of age. However, the efficacy of DHC in patients>60 years of age has rarely been investigated.
  
  
  METHODS
  A retrospective study was conducted in a single academic institution. Surrogates of patients with clinical signs of impending brain herniation despite standard medical therapy were offered the option of DHC regardless of age or the side of the lesion. The clinical data from 18 patients>60 years of age who underwent DHC for malignant hemispheric infarction in our institution were analyzed. Patients were classified into the following 2 groups: 61-70 and >70 years of age, and their demographics and surgical outcomes were compared. The variables compared included the male:female ratio, side of the lesion, type of stroke, site of vascular occlusion, use of thrombolytic therapy, National Institutes of Health Stroke Scale score, stroke onset-to-DHC interval, duration of hospital stay, infectious complications, and 90-day mortality rate.
  
  
  RESULTS
  There were no significant intergroup differences in any of the demographic variables evaluated. However, the 30-day mortality rate was significantly higher in the group that was >70 years of age (0% v 60%; P=.01) than in the group that was 61 to 70 years of age.
  
  
  CONCLUSIONS
  We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients>70 years of age would benefit from DHC.
authors.affiliation: Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Japan. Electronic address: inamasu@fujita-hu.ac.jp.
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kaito
authors.forename: Takeya
authors.initials: T
authors.lastname: Watabe
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ganaha
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamada
authors.forename: Teppei
authors.initials: T
authors.lastname: Tanaka
authors.forename: Shuei
authors.initials: S
authors.lastname: Imizu
authors.forename: Takuro
authors.initials: T
authors.lastname: Hayashi
authors.forename: Motoharu
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hirose
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery; D002544:Cerebral Infarction / Q000601:surgery; D056424:Decompressive Craniectomy / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Decompressive hemicraniectomy; malignant hemispheric infarction; surgical outcome; survival