Neurosurg Focus
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Review Comparative Study
Assessment of outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 60 years of age.
Decompressive surgery can be life saving after malignant cerebral infarction. However, severe residual disability occurs in a significant number of surviving patients. Most discussion about the benefits of surgery is based on studies performed in patients who are < or = 60 years of age. Less is known about the benefits of the procedure in the elderly population. The authors undertook a review of the literature on decompressive craniectomy for malignant cerebral infarction and compared the mortality and outcome data published in patients older and younger than 60 years of age. The authors discuss their analysis, with specific reference to the limitations of the studies analyzed, the outcome measures used, and the special considerations required when discussing stroke recovery in the elderly. ⋯ The mortality rate and functional outcome, as measured by the BI and mRS, were significantly worse in patients > 60 years of age following decompressive craniectomy for malignant infarction. Age is an important factor to consider in patient selection for surgery. However, cautious interpretation of the results is required because the outcome scores that were used only measure physical disability, whereas other factors, including psychosocial, financial, and caregiver burden, should be considered in addition to age alone.
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Comparative Study
Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases.
Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients. ⋯ Cranioplasty following decompressive craniectomy is associated with a high complication rate. Patients undergoing a bifrontal craniectomy are at significantly increased risk for postcranioplasty complications, including the need for reoperation.
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Comparative Study
Dynamics of subdural hygroma following decompressive craniectomy: a comparative study.
This retrospective comparative cohort study was aimed at discovering the risk factors associated with subdural hygroma (SDG) following decompressive craniectomy (DC) to relieve intracranial hypertension in severe head injury. ⋯ High dynamic accidents and patients with diffuse injury were more prone to SDGs. Close to 8% of SDGs converted themselves into subdural hematomas at approximately 2 months postinjury. Although SDGs developed in 39 (approximately 60%) of 68 post-DC patients, surgical evacuation was needed in only 4.
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Elevated intracranial pressure is one of the most common causes of death and disability following severe traumatic brain injury and ischemic stroke. Unfortunately, there have been no new medical treatments for cerebral edema and elevated intracranial pressure in more than 80 years. ⋯ When performed correctly, this procedure can reduce intracranial pressure and prevent cerebral herniation and death. The last decade has seen a renewed interest in the use of decompressive craniectomy, but many questions remain regarding patient selection, timing of surgery, surgical technique, timing of cranioplasty, and complications.
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Angiogram-negative subarachnoid hemorrhage (SAH) accounts for 15% of nontraumatic SAH and has been reported with low morbidity and mortality rates. We report on a large series of patients with angiogram-negative SAH who experienced an atypical nonbenign clinical course. ⋯ The authors' experience with a large series of angiogram-negative SAH patients who had an atypical nonbenign clinical course associated with hydrocephalus, vasospasm, stroke, and mortality differs significantly from previously published case series of angiogram-negative SAH.