gms | German Medical Science

69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

Artikel

Artikel empfehlen

Second-look strokectomy of cerebral infarction areas in patients with refractory intracranial pressure

Meeting Abstract

Suche in Medline nach

  • Michael Schwake - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Stephanie Schipmann - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Michael Müther - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Louise Stögbauer - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Uta Hanning - Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland; Universitätsklinikum Hamburg-Eppendorf, Klinik für diagnostische und interventionelle Neuroradiologie, Hamburg, Deutschland
  • Peter Sporns - Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
  • Christian Ewelt - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Rainer Dziewas - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland; Universitätsklinikum Münster, Klinik für Neurologie, Münster, Deutschland
  • Markus Holling - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Walter Stummer - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocP220

doi: 10.3205/18dgnc560, urn:nbn:de:0183-18dgnc5604

Veröffentlicht: 18. Juni 2018

© 2018 Schwake 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/.

Gliederung

Text

Objective: Decompressive craniectomies (DC) are performed on patients suffering large cerebral infarction with elevated intracranial pressure (ICP). The efficacy of this procedure has been shown in several studies. In some cases, however, this procedure alone is not sufficient and patients still develop refractory ICP. Earlier studies showed a devastating outcome for patients suffering infarction in more than one vascular territory. Resection of the infarcted area - strokectomy - has been propagated by some experts.

Methods: We retrospectively evaluated data of patients who underwent a DC due to a cerebral infarction in our department over the last years (2009-2016). Lesion type, side of stroke, age, sex, initial treatment, medical history of the patient including cardiovascular risk factors, National Institutes of Health-Score (NIHSS), Glasgow Coma Score (GSC), modified Rankin Score (mRS), intracranial pressure (ICP), CT scans and neurological symptoms were analyzed.

Results: Out of 199 patient who underwent DC due to cerebral infarction we identified 12 patients who underwent strokectomy with a mean age of 51.53 years (±15.52) (p<.001), median NIHSS of 19 (14–32) (p=.019). Either increased ICP above 20mmHg or dilated pupils and herniation on CT scan were triggers for surgery. Ten of 12 (83%) patients had an infarction in more than one vascular territory (p<.001). One patient died (8%), 83% survived and had a moderate neurological outcome (mRS ≤ 4 after 12 months). Age, NIHSS on admission and number of vascular territories involved were found as risk factors in multivariate analysis (p<0.05).

Conclusion: All strokectomies were performed as a lifesaving procedure. In comparison to former studies mortality rates were lower and clinical outcome was comparable to previously published studies regarding MCA infarctions. Second surgery including strokectomy may help achieve better outcomes even in cases of infarction of more than one vascular territory in young patients.