gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Outcome Prediction by Volume of Ischemic Brain in Malignant Middle Cerebral Artery Infarction treated by Decompressive Hemicraniectomy

Meeting Abstract

  • Christian Freyschlag - Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria
  • Christian Boehme - Neurochirurgie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Austria
  • Marlies Bauer - Neurochirurgie Innsbruck, Medizinische Universität Innsbruck, Innsbruck, Austria
  • Johannes Kerschbaumer - Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Claudia Unterhofer - Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Claudius Thomé - A.ö. Landeskrankenhaus - Universitätskliniken Innsbruck, Tirol Kliniken GmbH, Universitätsklinik für Neurochirurgie, Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.21.02

doi: 10.3205/17dgnc122, urn:nbn:de:0183-17dgnc1220

Published: June 9, 2017

© 2017 Freyschlag et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Malignant middle cerebral artery (MCA) infarction represents a life-threatening condition due to its space-occupying character. The surgical treatment outcome was assessed in multiple well-designed trials and showed strong evidence in favor of decompressive hemicraniectomy. However, the timeframe for decompressive surgery remains debatable and no objective criteria are found to facilitate the decision. We aimed to analyze imaging characteristics of patients with MCA-infarction for outcome prediction.

Methods: A retrospective analysis of 34 consecutive patients undergoing decompressive craniectomy was carried out. We used volumetric analysis through segmentation to determine the volume of the initial infarction and subsequently volumes on the first an 3rd postoperative day (pod1 and 3). The size of craniectomy was assessed and the time between onset and surgery. Outcome was measured as modified Rankin Scale (mRS), whereas favorable outcome was set for mRS ≤3.

Results: Median age of our patients was 53.5 years (25 – 72), the median time from the onset of first symptoms to surgical intervention was 38 hours (1 – 150) and the male: female ration was 2:1. The median ischemic volume was 250 cc (106 – 418) preoperatively, 315 cc (141 – 505) on pod1 and 349 cc (177 – 617) on pod3, respectively. A mRS ≤3 after 6 months could only be reached in 7 (20%) patients. Within the first 24 hours, the volume of infarction rose significantly (p=0.0003) and was associated with a worse outcome (p<0.0001) upon univariate analysis. In multivariate analysis, the volume on pod 3 showed a significant (p=0.014) correlation with outcome, so was the age upon onset (p=0.018).

Conclusion: A total infarct volume of >300cc in native CT-scan in patients undergoing hemicraniectomy, reliably predicts worse outcome for malignant MCA-infarction.