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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(09): 778-784
DOI: 10.1055/s-0043-1772602
Original Article

Outcomes of decompressive craniectomy for malignant middle cerebral artery stroke in an academic hospital in Brazil

Desfechos da craniectomia descompressiva para infarto maligno da artéria cerebral média em um hospital acadêmico no Brasil
Luiz Fernando Rodrigues de Oliveira 
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
,
Millene Rodrigues Camilo 
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
,
Luisa Franciscatto 
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
,
Guilherme Gozzoli Podolsky-Gondim 
2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
,
Frederico Fernandes Alessio Alves 
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
,
Rui Kleber do Vale Martins Filho 
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
,
Francisco Antunes Dias 
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
,
Koji Tanaka 
2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
,
Benedicto Oscar Colli 
2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
,
Octávio Marques Pontes-Neto 
1   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
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Abstract

Background Ischemic stroke is an important cause of death in the world. The malignant middle cerebral artery infarction (MMCAI) has mortality as high as 80% when clinically treated. In this setting, decompressive craniectomy is a life-saving measure, in spite of high morbidity among survivors.

Objective To evaluate the outcomes of patients with MMCAI treated with decompressive craniectomy in a Brazilian academic tertiary stroke center.

Methods A prospective stroke database was retrospectively evaluated, and all patients treated with decompressive craniectomy for MMCAI between January 2014 and December 2017 were included. The demographics and clinical characteristics were evaluated. The functional outcome, measured by the modified Rankin Scale (mRS), was assessed at hospital discharge, after 3-months and 1-year of follow-up.

Results We included 53 patients on the final analysis. The mean age was 54.6 ± 11.6 years and 64.2% were males. The median time from symptoms to admission was 4.8 (3–9.7) hours and the mean time from symptoms to surgery was 36 ± 17 hours. The left hemisphere was the affected in 39.6%. The median NIHSS at admission was 20 (16–24). The in-hospital mortality was 30.2%. After a median of 337 [157–393] days, 47.1% of patients had achieved favorable outcome (mRS ≤ 4) and 39.6% had died.

Conclusion Decompressive craniectomy is a life-saving measure in the setting of MMCAI, and its effects remains important in the scenario of a middle-income country in real-world situations.

Resumo

Antecedentes O acidente vascular cerebral (AVC) isquêmico é uma causa importante da morte em todo o mundo. O infarto maligno da artéria cerebral média (IMACM) tem mortalidade de até 80% quando tratado clinicamente. Nesse contexto, a craniectomia descompressiva é uma medida salvadora de vidas, apesar da alta morbidade entre os sobreviventes.

Objetivo Avaliar os desfechos dos pacientes com IMACM tratados com craniectomia descompressiva em um centro acadêmico terciário de AVC no Brasil.

Métodos Um banco de dados prospectivo de AVC foi avaliado retrospectivamente e todos os pacientes tratados com craniectomia descompressiva para IMACM entre janeiro de 2014 e dezembro de 2017 foram incluídos. As características clínicas e demográficas foram avaliadas. Os desfechos funcionais, medidos pela escala modificada da Rankin (mRS), foram avaliados na alta hospitalar, após 3 meses e após 1 ano de seguimento.

Resultados Foram incluídos 53 pacientes na análise final. A idade média foi 54,6 ± 11,6 anos e 64,2% eram homens. A mediana do tempo dos sintomas à admissão foi 4,8 (3–9,7) horas e o tempo médio dos sintomas à cirurgia foi 36 ± 17 horas. O hemisfério esquerdo foi o afetado em 39,6%. A pontuação na escala de AVC do National Institute of Health (NIHSS) à admissão foi 20 (16–24). A mortalidade hospitalar foi 30,2%. Após uma mediana de 337 (157–393) dias, 47,1% dos pacientes tinham atingido um desfecho favorável (mRS ≤ 4) e 39,6% tinham morrido.

Conclusão Craniectomia descompressiva é uma medida salvadora de vidas no contexto do IMACM e seus efeitos permanecem importantes no cenário de um país em desenvolvimento em situação de vida real.

Keywords

Stroke - Decompressive Craniectomy - Infarction, Middle Cerebral Artery

Palavras-chave

Acidente Vascular Cerebral - Craniectomia Descompressiva - Infarto da Artéria Cerebral Média

Authors' Contributions

LFRO: contributed to study conception and design, data collection, statistical analysis, first draft; MRC: contributed to study conception and design, statistical analysis e manuscript revisions; LF: contributed to data collection; GGPG: contributed to data collection; FFAA: contributed to data collection; RKM: contributed to data collection; FAD: contributed to data collection; Tanaka, K contributed to data collection; BOC: contributed to interpretation of results and manuscript review and editing; OMPN: contributed to study conception and design, statistical analysis and manuscript revisions. All authors reviewed the results and approved the final version of the manuscript.




Publication History

Received: 30 January 2023

Accepted: 02 May 2023

Article published online:
04 October 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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