Assessing the effect of decopmression surgery performed due to malignant ischemic stroke on the quality of life

Yıl 2021, , 103 - 108, 25.06.2021

Fatma Şimşek , Nuray Bilge , Mehmet Nuri Koçak , Mustafa Ceylan , Alper Eren , Recep Yevgi , Nuh Çağrı Karaavcı

https://doi.org/10.33716/bmedj.907982

Öz

Aim: Decompressive craniectomy is one of the treatment methods that reduces mortality, when used in eligible patients for the treatment of malignant ischemic stroke (MIS). In this study, we

aimed to assess the effect of age and the timing of surgery on the quality of life and on the prognosis of patients that underwent decompressive craniectomy.

Material and Method: The files of 45 patients between the ages of 24-98, who were recommended decompressive craniectomy in connection with malignant ischemic stroke, were reviewed within the scope of the study. Result: 27 (60%) patients, who agreed to undergoing surgery, and 18 (40%) patients, who did not agree to undergoing surgery, were taken under review. A significant improvement (between 0 and 3) was observed in the modified Rankin Scale Scores of the two patients that underwent surgery. All the patients (n = 4) from within the group of patients that did not agree to a surgery, who lived for more than 6 months, were found to have a modified Rankin Scale Score of 5 and needed support to fulfill their daily life activities. Conclusion: It has been observed that performing a decompressive craniectomy after 72 hours following clinical deterioration and radiological shift did not have a significant effect on mortality and morbidity. Studies with larger patient groups are needed to be carried out in order to determine the applicability criteria of surgical treatment.

Anahtar Kelimeler

stroke, decompressive craniectomy, prognosis, mortality

Malign iskemik inmede dekompresyon cerrahinin yaşam kalitesi üzerine etkisinin değerlendirilmesi

Öz

Amaç: Dekompressif kraniektomi malign iskemik inme tedavisinde uygun hastalarda kullanıldığında mortaliteyi azaltan tedavi yöntemlerinden biridir. Çalışmamızda dekompressif

kraniektomi yapılan hastalarda operasyon zamanı ve yaşın, yaşam kalitesi ve prognoz üzerine etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Malign iskemik inme nedeni ile dekompressif kraniektomi önerilen 24-98 yaş aralığında, 45 hastanın dosyası incelendi. Hastalar cerrahi yapılan ve cerrahiyi kabul etmeyerek sadece konservatif tedavi uygulanan iki gruba ayrılarak değerlendirildi. Bulgular: Operasyonu kabul eden n=27 (%60) hasta ve operasyonu kabul etmeyen n=18 (%40) hasta incelendi. Cerrahi yapılan grupta iki hastanın modifiye Rankin Skorunda belirgin iyileşme görüldü (0-3 arasında). Cerrahiyi kabul etmeyen grupta 6 aydan uzun süre yaşayan hastaların hepsinde (n=4) modifiye Rankin Skoru: 5 olup günlük yaşam aktivitelerinde desteğe ihtiyaçları vardı.Sonuç: Klinik kötüleşme ve radyolojik olarak şift görüldükten 72 saat sonra yapılan dekompresif kraniektominin mortalite ve morbidite üzerinde anlamlı bir etkisinin olmadığı görülmektedir. Cerrahi tedavinin uygulanabilirlik kriterlerini belirlemek için daha büyük hasta grupları ile yapılacak çalışmalara ihtiyaç vardır. 

Anahtar Kelimeler

iskemik inme, dekompresyon kraniektomi, prognoz, mortalite

Kaynakça

• Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2017; 390:1151-1210.DOI: 10.1016/S0140-6736(17)32152-9.
• Go A, Mozaffarian D, Roger V, Benjamin E, Berry J, Blaha M. Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2014 update: a report from the American Heart Association Circulation 2014; 129:e28-e292. DOI: 10.1161/01.cir.0000441139.02102.80.
• Frank JI. Large hemispheric infarction, deterioration, and intracranial pressure. Neurology 1995; 45:1286-1290. DOI:10.1212/WNL.45.7.1286.
• Kasner SE, Demchuk AM, Berrouschot Jr, Schmutzhard E, Harms L, Verro P, et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke 2001;32:2117-2123. DOI: 10.1161/hs0901.095719.
• Pullicino P, Alexandrov A, Shelton J, Alexandrova N, Smurawska L, Norris J. Mass effect and death from severe acute stroke. Neurology 1997; 49:1090-1095. DOI: 10.1212/WNL.49.4.1090
• Wijdicks EF, Sheth KN, Carter BS, Greer DM, Kasner SE, Kimberly WT, et al. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:1222-1238. DOI: 10.1161/01.str.0000441965.15164.d6
• Wijdicks EF, Diringer MN. Middle cerebral artery territory infarction and early brain swelling: progression and effect of age on outcome. Elsevier 1998: 829-836. DOI:10.4065/73.9.829.
• Lu X, Huang B, Zheng J, Tao Y, Yu W, Tang L, et al. Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery. Scientific reports 2014;4:1-9.
• Moussaddy A, Demchuk AM, Hill MD. Thrombolytic therapies for ischemic stroke: Triumphs and future challenges. Neuropharmacology 2018; 134:272-279. DOI:10.1016/j.neuropharm.2017.11.010
• Kolias AG, Kirkpatrick PJ, Hutchinson PJ. Decompressive craniectomy: past, present and future. Nature Reviews Neurology 2013; 9:405-415.
• Schwab S, Rieke K, Aschoff A, Albert F, von Kummer R, Hacke W. Hemicraniotomy in space-occupying hemispheric infarction: useful early intervention or desperate activism? Cerebrovascular Diseases 1996; 6:325-329. DOI: 10.1159/00010804
• Wirtz CR, Steiner T, Aschoff A, Schwab S, Schnippering H, Steiner HH, et al. Hemicraniectomy with dural augmentation in medically uncontrollable hemispheric infarction. Neurosurgical Focus 1997; 2:E7. DOI: 10.3171/foc.1997.2.5.7
• Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. The Lancet Neurology 2007; 6:215-222. DOI: 10.1016/S1474-4422(07)70036-4
• Dasenbrock HH, Robertson FC, Vaitkevicius H, Aziz-Sultan MA, Guttieres D, Dunn IF, et al. Timing of decompressive hemicraniectomy for stroke: a nationwide inpatient sample analysis. Stroke 2017; 48:704-711. DOI: 10.1161/ STROKEAHA.116.014727
• Kilic M, Ertem DH, Ozdemir B. Timing of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction: A Single-Center Analysis. Medicina 2019; 55:31. DOI: 10.3390/medicina55020031
• Chua A, Buckley BS, Lapitan M, Jamora R. Hemicraniectomy for malignant middle cerebral artery infarction (HeMMI): a randomized controlled clinical trial of decompressive surgery with standardized medical care versus standardized medical care alone. Acta Med Philipp. 2015; 49
• Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 2007; 38:2506-2517. DOI: 10.1161/STROKEAHA.107.485235
• Jüttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, Woitzik J, et al. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY) a randomized, controlled trial. Stroke 2007; 38:2518-2525. DOI: 10.1161/STROKEAHA.107.485649
• Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. The Lancet Neurology 2009; 8:326-333.DOI:10.1016/S1474-4422(09)70047-X
• Zhao J, Su YY, Zhang Y, Zhang YZ, Zhao R, Wang L, et al. Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old. Neurocritical care 2012; 17:161-171.DOI: 10.1007/s12028-012-9703-3
• Jüttler E, Unterberg A, Woitzik J, Bösel J, Amiri H, Sakowitz OW, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. New England Journal of Medicine 2014; 370:1091-1100. DOI: 10.1056/NEJMoa1311367
• Slezins J, Keris V, Bricis R, Millers A, Valeinis E, Stukens J, et al. Preliminary results of randomized controlled study on decompressive craniectomy in treatment of malignant middle cerebral artery stroke. Medicina 2012; 48:76.