Artikel
Factors determining outcome following decompressive craniectomy for ischemic stroke, traumatic brain injury and subarachnoid hemorrhage
Einflussfaktoren auf das Outcome nach dekompressiver Kraniektomie aufgrund von malignem ischämischen Schlaganfall, Schädel-Hirn-Trauma und Subarachnoidalblutung
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Veröffentlicht: | 11. April 2007 |
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Objective: In the course of malignant ischemic stroke (IS), traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH), the intracranial pressure (ICP) can increase dramatically. As a last desperate solution, neurosurgery can offer decompressive craniectomy (DC). However, factors influencing the functional outcome are still being discussed controversly. We attempted to identify clinical predictors in terms of survival and functional outcome.
Methods: In retrospect we analysed n=100 patients aged from 2 months - 72 years (mean=49), who had undergone DC for IS (n=57), TBI (n=22) and SAH (n=21). Functional outcome was assessed using the Glasgow Outcome Sale (GOS). The different entities (IS, TBI, SAH) were statistically compared using nonparametric tests to identify individual influencing factors. GCS-value at time of indication, age, level of ICP, duration of symptoms and hemispheric localisation were analyzed in detail. The level of significance was set at p<0,05.
Results: SAH-patients showed a significantly worse outcome when compared to patients with IS after a mean of 9 months. A GCS-value lower than 6 at the time of indication for DC is associated with a significantly worse outcome. Age, level and duration of elevated ICP did not significantly influence the outcome. There was no evidence that hemispheric dominance of the affected side influences functional outcome.
Conclusions: Patients with a monohemispheric lesion like IS are more likely to benefit from DC than patients with multifocal lesions due to vasospasm after SAH. The condition of the patient at the time of indication for DC as assessed by GCS determines the outcome. Age, duration of ICP elevation or lateralization of the lesion do not influence outcome. This is contrary to current publications of the American Heart Association concerning DC.