Infarct volume predicts outcome after decompressive hemicraniectomy for malignant hemispheric stroke

J Cereb Blood Flow Metab. 2018 Jun;38(6):1096-1103. doi: 10.1177/0271678X17718693. Epub 2017 Jun 30.

Abstract

The decision to perform decompressive hemicraniectomy (DHC) by default in malignant hemispheric stroke (MHS) remains controversial. Even under ideal conditions, DHC usually results in moderate to severe disability. The present study for the first time uses neuroimaging to identify independent outcome predictors in a prospective cohort of 96 MHS patients undergoing DHC. The primary outcome was functional status according to the modified Rankin Scale (mRS) at 12 months and categorized as favorable (mRS 0-3) or unfavorable (mRS 4-6). At 12 months, 19 patients (20%) reached favorable and 77 patients (80%) unfavorable outcome. The overall mean infarct volume was 328 ± 114 ml. Multivariable logistic regression identified age per year (OR 1.14, 95% CI 1.04-1.24; p = 0.005), infarct volume per cm3 (OR 1.012, 95% CI 1.003-1.022; p = 0.013), thalamic involvement (OR 8.65, 95% CI 1.04-72.15; p = 0.046) and postoperative pneumonia (OR 5.52, 95% CI 1.03-29.57; p = 0.046) as independent outcome predictors, which was confirmed by multivariable ordinal regression for age ( p = 0.004) and infarct volume ( p = 0.015). The infarct volume threshold for reasonable prediction of unfavorable outcome in our patients was 270 cm3, which in the future may help prognostication and development of clinical trials on DHC and outcome in MHS.

Keywords: Acute stroke; MRI; cerebrovascular disease; neurosurgery; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Brain Infarction* / mortality
  • Brain Infarction* / pathology
  • Brain Infarction* / physiopathology
  • Brain Infarction* / surgery
  • Brain Neoplasms* / mortality
  • Brain Neoplasms* / pathology
  • Brain Neoplasms* / physiopathology
  • Brain Neoplasms* / surgery
  • Decompressive Craniectomy*
  • Disease-Free Survival
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stroke* / mortality
  • Stroke* / pathology
  • Stroke* / physiopathology
  • Stroke* / surgery
  • Survival Rate