Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke.

Abstract:

BACKGROUND:Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. OBJECTIVE:To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. METHODS:Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. RESULTS:A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). CONCLUSION:In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability.

journal_name

Arq Neuropsiquiatr

authors

Maia IHM,Melo TP,Lima FO,Carvalho JJF,Mont'alverne FJA,Lopes JÚnior E,DiÓgenes MB,Cunha TSL,Queiroz BMA,Tamietti MF,Maia FM

doi

10.1590/0004-282X20200006

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

349-355

issue

6

eissn

0004-282X

issn

1678-4227

pii

S0004-282X2020005011206

journal_volume

78

pub_type

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