Abstract:
BACKGROUND:Pooled European trial results of early decompressive craniectomy (DC) for severe hemispheric stroke did not require radiographic mass effect as an inclusion criterion. Early surgery for supratentorial cerebral hemorrhage does not improve functional status or survival compared to initial conservative medical management. Early versus delayed DC for hemispheric stroke has not been investigated. METHODS AND RESULTS:A prospective inpatient neurosurgical database from October 2007 to March 2015 was queried for neurocritical care admissions for hemispheric ischemic stroke in patients aged 18-60 under IRB approval. A retrospective chart review was conducted using a structured questionnaire and the electronic medical record. We identified 30 patients who met the inclusion criteria for the pooled European early DC stroke trial. The mean age was 46, and the median NIH stroke score was 19. All hemispheric stroke patients were monitored in the neurocritical care unit with hourly neurochecks and daily CT scans for a minimum of 3 days. Eighteen patients (60 %) were managed with medical treatment only (MTO) with an average maximal septal shift of 5.2 mm and a pineal shift of 3.1 mm. Twelve patients (40 %) underwent DC with an average maximal septal shift of 6.8 mm and a pineal shift of 4.1 mm. Modified Rankin (MR) outcomes at 3 months for the overall group, MTO, and DC were as follows: MR 0-3 60 % versus 67 % versus 50 %; MR 4-5 27 % versus 17 % versus 42 %; and death 13 % versus 17 % versus 8 %, respectively. Four patients in the MTO group declined DC; 3 died and one survived with an MR of 4. No patients developed brainstem herniation prior to referral for DC. Surgical complications occurred in 4/12 (33 %) patients. CONCLUSIONS:Delayed DC for hemispheric stroke patients managed under protocol in the neurocritical care unit is a safe alternative to early, prophylactic DC for adults with severe hemispheric stroke. This strategy reduced DC rates by 60 % without an excess of death or survival with severe disabilities.
journal_name
Neurocrit Carejournal_title
Neurocritical careauthors
Akins PT,Axelrod YV,Arshad ST,Guppy KHdoi
10.1007/s12028-016-0270-xsubject
Has Abstractpub_date
2016-08-01 00:00:00pages
3-9issue
1eissn
1541-6933issn
1556-0961pii
10.1007/s12028-016-0270-xjournal_volume
25pub_type
杂志文章abstract:BACKGROUND:This prospective study of an innovative non-invasive ultrasonic cerebrovascular autoregulation (CA) monitoring method is based on real-time measurements of intracranial blood volume (IBV) reactions following changes in arterial blood pressure. In this study, we aimed to determine the clinical applicability o...
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pub_type: 杂志文章
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journal_title:Neurocritical care
pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.1385/NCC:5:2:134
更新日期:2006-01-01 00:00:00
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更新日期:2021-01-25 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2017-08-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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更新日期:2008-01-01 00:00:00
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更新日期:2009-01-01 00:00:00
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
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更新日期:2011-08-01 00:00:00
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更新日期:2012-02-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/s12028-020-01090-3
更新日期:2020-09-09 00:00:00
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pub_type: 杂志文章,评审
doi:10.1385/ncc:4:1:083
更新日期:2006-01-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2012-12-01 00:00:00
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更新日期:2009-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2007-01-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2020-08-04 00:00:00
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journal_title:Neurocritical care
pub_type: 临床试验,杂志文章
doi:10.1385/NCC:3:1:016
更新日期:2005-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/s12028-019-00747-y
更新日期:2020-04-01 00:00:00
abstract:INTRODUCTION:Delayed ischemic deficit from vasospasm is a leading cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage. Although several treatment modalities have been used to reverse the deleterious effects of vasospasm, alternative therapies are needed, as conventional therapies are often ineffec...
journal_title:Neurocritical care
pub_type: 杂志文章
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更新日期:2008-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2014-08-01 00:00:00
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pub_type: 杂志文章
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更新日期:2015-12-01 00:00:00
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pub_type: 杂志文章
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