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Vol. 31. Issue 1.
Pages 7-13 (January - February 2020)
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Vol. 31. Issue 1.
Pages 7-13 (January - February 2020)
Clinical Research
DOI: 10.1016/j.neucie.2019.07.002
Decompressive craniectomy in malignant middle cerebral artery infarction: family perception, outcome and prognostic factors
Craniectomía descompresiva en el infarto malignode arteria cerebral media: percepción familiar, resultados y factores pronósticos
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Pablo García-Feijooa,
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g.feijoo.neurosurgery@gmail.com

Corresponding author.
, Alberto Islaa, Exuperio Díez-Tejedorb, Beatriz Mansillaa, Alexis Palpan Floresa, Miguel Sáez-Alegrea, Catalina Vivancosa
a Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, Spain
b Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
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Table 1. Patient characteristics.
Table 2. Main complications recorded after decompressive hemicraniectomy.
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Abstract
Background

The prognosis of one hemisphere malignant infarction creates doubt among neurosurgeons about decompressive hemicraniectomy indication. What results are achieved in the short to medium term? Are families satisfied with the surgery once the patient is at home? In the present study, we analyze our experience in this matter during the last thirteen years.

Methods

In our review, twenty-one patients were included from 2004 to 2017, according to the protocol for the management of ischaemic stroke that is implemented in our institution. The relatives were interviewed by telephone. The functional outcome at discharge, 3 months, 1year, and at present was measured using the modified Rankin scale (mRS).

Results

Patient age was shown to be directly related to the mRS (r=0.56; p=0.035) and 37.5% achieved a good outcome (mRS≤3). 78.9% of the interviewed relatives would repeat the surgical decision.

Conclusion

We present a 21 patients group where the best outcome was achieved in patients ≤60 years old. The severe neurological sequelae in patients with malignant infarction subjected to decompressive hemicraniectomy are tolerated and accepted by most families to the benefit of survival. We must not let this family satisfaction hide the prognosis, having to contextualize it within the real ambulatory situation of the patients.

Keywords:
Malignant middle cerebral artery infarction
Decompressive craniectomy
Outcome
mRS
Family
Resumen
Objetivo

El pronóstico en los infartos malignos de un hemisferio siembra dudas entre los neurocirujanos a la hora de indicar una hemicraniectomía descompresiva. ¿Qué resultados a corto y medio plazo se obtienen? ¿están las familias satisfechas con la cirugía una vez con el enfermo en su domicilio?. En el presente trabajo analizamos nuestra experiencia en esta materia en los últimos 13 años.

Material y métodos

Incluimos en nuestra revisión a 21 pacientes intervenidos entre 2004 y 2017 siguiendo la vía clínica de nuestro centro para el ictus. Se entrevistó a los familiares vía telefónica. Se midió el resultado funcional al alta, 3 meses, 1 año y actual con la escala modificada de Rankin (mRS).

Resultados

La edad demostró estar directamente relacionada con la mRS (r=0.56; p=0.035) y en el 37.5% se obtuvo un buen resultado (mRS≤3). El 78.9% de los familiares entrevistados repetiría la decisión quirúrgica tomada.

Conclusiones

Aportamos un grupo de 21 pacientes sometidos a craniectomía descompresiva por infarto maligno donde los mejores resultados funcionales se han dado entre los <60 años. Las graves secuelas neurológicas en pacientes con infarto maligno sometidos a hemicraniectomía descompresiva fueron toleradas y aceptadas por la mayoría de familias a favor de su supervivencia. No debemos dejar que esta satisfacción familiar camufle el pronóstico, teniendo que contextualizarla dentro de la situación real ambulatoria de los pacientes.

Palabras clave:
Infarto maligno de arteria cerebral media
Craniectomía descompresiva
Resultados
mRS
Familia

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