Hemicraniectomy after massive hemispheric cerebral infarction: are we ready for a prospective randomised controlled trial?
- Correspondence to: Dr Kevin M Cockroft PO Box 850, Department of Neurological Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA; kcockroftpsu.edu
Quality of survival after hemicraniectomy remains a key factor
Hemicraniectomy for massive cerebral infarction remains a controversial issue within neurosurgery and neurology. In this issue, Uhl et al1 provide us with valuable insight into the factors that influence outcome in this situation. Their multi-institution report is the largest case series of patients who have undergone decompressive craniectomy for massive space occupying cerebral infarction. The pooling of databases from eight neurosurgical departments resulted in the inclusion of 188 patients with a median follow up of 26 weeks. The authors assessed various prognostic factors including sex, age, presence of anisocoria, Glasgow coma score, extension of infarction, laterality, pre-existing medical conditions, and time from infarction to surgery. Unadjusted three, six, and 12 month mortality rates were 7.9%, 37.6%, and 43.8%, respectively. In the multivariate analysis, only age (over 50 years) and extension of infarction (involvement of two or more vascular territories) proved to be independent predictors of death.
Although this article suggests answers to several questions regarding the management of patients …
