title: [Survey regarding the treatment of malignant middle cerebral artery infarction in German hospitals].
abstract: BACKGROUND
  There are a variety of intensive care therapies in the treatment of malignant middle cerebral artery infarction (MMI) besides hemicraniectomy (HC), the only treatment with proven efficacy. It is, however, not known how HC and conservative treatments are utilized in German hospitals, Furthermore, data on the care-situation of patients with MMI in Germany is scarce.
  
  
  METHODS
  An anonymous questionnaire was sent to 297 neurological and 133 neurosurgical hospitals in Germany.
  
  
  RESULTS
  The Response rate was 24,7%. Most respondents indicated personal experience in the treatment of MMI (83,3%). HC is usually performed early on site (83,3%). Indication to HC is confirmed on a high level of hierarchy and profession using clinical and radiological criteria in 78,2% of hospitals. Inherent standardized treatment protocols are established in 70,8% of hospitals. Patients are treated on an intensive care unit in 74,5% of hospitals after DHC and in 42,5% of hospitals under non-surgical treatment. Intracranial pressure monitoring is not performed on a regular basis. Differing opinions were observed concerning diagnosis and treatment of MMI without recognizable consensus.
  
  
  CONCLUSIONS
  Basically, structural requirements for the treatment of MMI exist in the participating hospitals. Heterogeneity in the treatment of MMI is striking. The implementation of treatment protocols and adherence to guidelines are desirable steps to optimize treatment.
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Ulm, Oberer Eselsberg 45, 89081, Ulm, Deutschland. hermann.neugebauer@uni-ulm.de.
authors.forename: H
authors.initials: H
authors.lastname: Neugebauer
authors.affiliation: Institut für klinische Epidemiologie und Biometrie, Universitätsklinik Würzburg, Deutsches Zentrum für Herzinsuffizienz, Josef-Schneider-Str. 2/Haus D7, 97080, Würzburg, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Wiedmann
authors.affiliation: Neurologische Klinik, Ostalb-Klinikum Aalen, Im Kälblesrain 1, 73043, Aalen, Deutschland.
authors.forename: E
authors.initials: E
authors.lastname: Jüttler
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data; D056424:Decompressive Craniectomy / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies
keywords: Decompression surgery; Hemicraniectomie; Malignant middle cerebral artery infarction; Survey
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