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67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

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Postoperative midline shift as outcome predictor for decompressive craniectomy after malignant cerebral infarction

Meeting Abstract

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  • Christopher Munoz-Bendix - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
  • Marcel Alexander Kamp - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
  • Kerim Beseoglu - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
  • Hans-Jakob Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 128

doi: 10.3205/16dgnc503, urn:nbn:de:0183-16dgnc5031

Veröffentlicht: 8. Juni 2016

© 2016 Munoz-Bendix et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

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Text

Objective: Decompressive craniectomy (DC) after malignant cerebral infarction (MCI) leads to improved survival. Outcome predictors are still lacking. We sought to determine if postoperative midline shift (MLS) is related to the clinical outcome in patients following DC after MCI.

Method: Ninety-six patients diagnosed with MCI and treated with DC in a seven-year period were retrospectively studied. Preoperative Glasgow Coma Scale (GCS) of the patients, artery involved, localization, postoperative MLS, and outcome were evaluated. Outcome was measured by the modified Rankin Scale (mRS) at 3-months following surgery.

Results: From the ninety-six patients evaluated, 37 were females. Mean age was 55.9 years. Mean preoperative GCS was 9 (GCS≥3-8, (42.7%); GCS 9-12, (36.5%); GCS>12, (20.8%). In 27.1% of the patients more than one cerebral artery was involved. A total of 43 patients (44.7%) had a left-sided MCI. Maximal postoperative MLS varied from 0mm to 27mm, mean 6.7 mm. None of the patients presented a mRS of 0 or 1 at three months (for mRS 2, n= 5 (5.2%); mRS 3, n= 21 (21.9%); mRS 4 n= 46 (47.9%); mRS 5, n= 14 (14.6%)). Ten patients (10.4%) died within 3 months. Non-parametric bivariate analysis showed poorer outcome the higher the postoperative MLS was (rs=0.22; Z=2.21>Zcrit=1.645; p=0.011). Outcome was worse, if more than one cerebral arteriy was involved (rs=-0.27; Z=2.60>Zcrit=1.645; p=0.0459). Infarction side had no influence on the outcome of patients (chi-square=3.05; chi-crit=11.07; p>0.05).

Conclusions: Our study indicates that persisting or increasing postoperative MLS after DC predicts poor outcome in patients following a MCI. Further studies are needed in order to determine whether technical modifications of surgical treatment can reduce postoperative MLS and possibly improve outcome.