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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

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Second-look Strokectomy of Cerebral Infarction Areas in Petients with Severe Herniation

Meeting Abstract

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  • Michael Schwake - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Stefanie Schipmann - Universitätsklinikum Münster, Münster, Deutschland
  • Christian Ewelt - Klinik für Neurochirurgie, Universitätsklinik Münster, Münster, Deutschland
  • Markus Holling - Universitätsklinikum Münster, Münster, Deutschland
  • Walter Stummer - Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland

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. DocP 172

doi: 10.3205/17dgnc735, urn:nbn:de:0183-17dgnc7356

Published: June 9, 2017

© 2017 Schwake 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: Decompressive craniectomies (DC) are performed on patients suffering from a large volume cerebral infarction or severe traumatic brain injury (TBI) with elevated intracranial pressure (ICP). The efficacy of this procedure has been shown in several studies. Yet, in some cases this procedure alone is not sufficient and patients still suffer from high ICP and uncal herniation. Former studies showed a very bad outcome for patients suffering infarction in more than one vascular territory and some authors consider DC as unhelpful in these cases. Resection of the infarction area -strokectomy- is propagated by some experts.

Methods: We retrospectively evaluated data of patients who underwent a DC due to infarction in our department in the last years (2011-2016). Lesion type, side of pathology, age, sex, initial treatment, history of the patient including cardiovascular risk factors, National Institutes of Health-Score (NIHSS), Glasgow Coma Score (GSC), Glasgow Outcome Score (GOS), modified Rankin Score (mRS), intracranial pressure (ICP), CT scans and neurological symptoms were analyzed.

Results: We detected 10 patients who underwent second-look strokectomy (mean age was 52,05 ±16,99 years, median NIHSS 19 (15–32) and GCS 9 (3-12)) after initial DC. Refractory increased ICP above 20mmHg and herniation on CT scan were triggers for surgery. Eight of 10 (80%) patients had an infraction in more than one vascular territory. One patient died (10%), 80% survived and had a moderate neurological outcome (mRS ≤ 4 after 12 months).

Conclusion: All strokectomies were performed as a lifesaving procedure. In comparison to former studies mortality rate was lower and clinical outcome was comparable to previously published RCTs regarding MCA infarctions. Second-look surgery including strokectomy may indorse much acceptable outcome even in cases of infarction in more than one vascular territory.