title: Improved hemodynamic parameters in middle cerebral artery infarction after decompressive craniectomy.
abstract: OBJECTIVE
  Decompressive craniectomy (DC) reduces mortality and improves functional outcome in patients with malignant middle cerebral artery infarction. However, little is known regarding the impact of DC on cerebral hemodynamics. Therefore, our goal was to study the hemodynamic changes that may occur in patients with malignant middle cerebral artery infarction after DC and to assess their relationship with outcomes.
  
  
  METHODS
  Twenty-seven patients with malignant middle cerebral artery infarction who were treated with DC were studied. The perfusion CT hemodynamic parameters, mean transit time, cerebral blood flow, and cerebral blood volume were evaluated preoperatively and within the first 24 hours after DC.
  
  
  RESULTS
  There was a global trend toward improved cerebral hemodynamics after DC. Preoperative and postoperative absolute mean transit times were associated with mortality at 6 months, and the ratio of post- and preoperative cerebral blood flow was significantly higher in patients with favorable outcomes than those with unfavorable outcomes. Patients who underwent surgery 48 hours after stroke, those with midline brain shift>10 mm, and those who were >55 years showed no significant improvement in any perfusion CT parameters.
  
  
  CONCLUSIONS
  DC improves cerebral hemodynamics in patients with malignant middle cerebral artery infarction, and the level of improvement is related to outcome. However, some patients did not seem to experience any additional hemodynamic benefit, suggesting that perfusion CT may play a role as a prognostic tool in patients undergoing DC after ischemic stroke.
authors.affiliation: From the Division of Neurosurgery (R.L.A., A.F.d.A., W.S.P., M.J.T., E.B.-S.-S.) and Department of Radiology (G.S.G., M.M.), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Robson Luis
authors.initials: RL
authors.lastname: Amorim
authors.forename: Almir Ferreira
authors.initials: AF
authors.lastname: de Andrade
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Gattás
authors.forename: Wellingson Silva
authors.initials: WS
authors.lastname: Paiva
authors.forename: Marcos
authors.initials: M
authors.lastname: Menezes
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.forename: Edson
authors.initials: E
authors.lastname: Bor-Seng-Shu
mesh_terms: D000328:Adult; D002560:Cerebrovascular Circulation / Q000502:physiology*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D011379:Prognosis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: cerebral infarction; decompressive craniectomy; perfusion imaging