gms | German Medical Science

Objective: Decompressive craniectomy (DC) is performed as a life-saving procedure in selected patients suffering from acute ischemic stroke (AIS). Postoperative midline shift (MLS) has been previously suggested as predictor for poor clinical outcome in patients with AIS and DC. However, data on postoperative MLS is still scarce. Therefore, we analyzed patients undergoing DC due to AIS, with special attention to postoperative midline shift and functional outcome.

Method: From 2006 to 2014, 66 patients suffering from AIS underwent subsequent DC at the authors' institution. Patient characteristics, pre- and postoperative MLS, and functional outcome were assessed and further analyzed. Patients were divided into two groups according to the postoperative MLS (<5mm versus ≥5mm). Outcome was assessed according to the modified Rankin Scale (mRS) after 6 months (mRS 0-3 favourable versus mRS 4-6 unfavourable).

Results: Overall, favourable outcome was achieved in 11 patients (17%). Patient characteristics did not differ between patients with and without favourable outcome. Furthermore, size of infarction did not differ between patients who achieved favourable outcome and patients with unfavourable outcome. Patients with postoperative MLS <5mm achieved favourable outcome significantly more often compared to patients with postoperative MLS ≥5mm (11% vs. 0%; p=0.03, OR 11.3).

Conclusions: The present data suggest that patients with postoperative MLS <5mm after DC might achieve better functional outcome during follow-up. This might help early patient stratification.