gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Effectiveness and problems of decompressive craniectomy for brain infarction

Meeting Abstract

  • S. Tsugane - Department of Neurosurgery, Nagoya Medical Center, Nagoya, Japan
  • M. Oheda - Department of Neurosurgery, Nagoya Medical Center, Nagoya, Japan
  • A. Tsurumi - Department of Neurosurgery, Nagoya Medical Center, Nagoya, Japan
  • N. Suzaki - Department of Neurosurgery, Nagoya Medical Center, Nagoya, Japan
  • T. Takahashi - Department of Neurosurgery, Nagoya Medical Center, Nagoya, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 104

DOI: 10.3205/12dgnc491, URN: urn:nbn:de:0183-12dgnc4914

Published: June 4, 2012

© 2012 Tsugane et al.
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Outline

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Objective: The Japanese Guidelines for the Management of Stroke 2009 strongly recommend the decompressive craniectomy for the treatment of a malignant middle cerebral artery infarction in case of not an advanced age (from 18 to 60 years old), mild consciousness disturbance, etc. Antiplatelet agents and anticoagulants that are used in a preoperative treatment often cause the difficulty of hemostasis. It is still to be considered when the postoperative administration of the antiplatelet agents or the anticoagulants is begun.

Methods: Authors studied the modified Rankin Scale (mRS) and the administration of the antiplatelet agents or the anticoagulants the cases that had undergone the decompressive craniectomy. The dura was opened and mended with an artificial dura. Infarct brain tissue was resected when the brain herniation was anticipated owing to the continuing compression of the space-occupying lesion.

Results: Thirteen patients underwent the decompressive craniectomy because of brain infarction from January 2010 to October 2011. Preoperative consciousness level was drowsy or comatose. Though perioperative death was observed in 2 patients, the death owing to the brain herniation was not experienced. Mean postoperative mRS (1 month after the surgery) was 3.8 in all 13 cases. Four of the 13 cases had a history of atrial fibrillation (AF). Mean postoperative mRS of these 4 was 4.8. Four cases were used antiplatelet agents before the surgery. Intraoperative blood transfusion of platelets was performed and postoperative bleeding was not observed in these 4 cases. One patient began to take warfarin on the 9th day of the surgery. However, warfarin had to be ceased because hemorrhagic infarction occurred. Another patient exacerbated on the 5th day after the surgery because of the embolic infarction. When the antiplatelet therapy is necessary, it was begun after the cranioplasty.

Conclusions: This small study shows that the prognosis of the patient with AF has a tendency to be worse. The blood transfusion of platelets may be effective in the case of the preoperative administration of the antiplatelet agents. Postoperative anticoagulant therapy sometimes causes hemorrhagic infarction. However, the delay of the beginning of the medicine may cause the second infarction. Physicians may need to decide the time of the prescription of the antiplatelet agents or the anticoagulants according to the case.