Hemicraniectomy remains an interesting and somewhat controversial topic as we continue to sort out which patient populations may most benefit. The mortality benefit, even in the absence of controlled studies appears clear. Recent reports are now beginning to look at morbidity following such large strokes. This report addresses some of those questions…
Prognosis of patients after hemicraniectomy in malignant middle cerebral artery infarction.Walz B, Zimmermann C, Bottger S, Haberl RLWalz B, Zimmermann C, Bottger S, Haberl RLJ Neurol 2002 Sep;249(9):1183-90
Walz B, Zimmermann C, Bottger S, Haberl RLJ Neurol 2002 Sep;249(9):1183-90In the report, the authors looked at outcome in 18 patients who had undergone decompressive craniectomy. 6 patients died within 6 months of the procedure and 12 patients underwent more detailed follow-up studies. The mean Barthel Index of survivors was 21.1 The Barthel average for those patients under 45 years was 75.5. The authors also treated 5/18 patients with dominant hemispheric infarcts and noted “Fourr had a slight to moderate Broca aphasia and one patient a global aphasia. ” 11/12 survivors approved in retrospect the decision that had been made to proceed with hemicraniectomy.
Comments: Hemicraniectomy continues to come more into the mainstream of neurosurgical practice. Several studies have now shown that the Barthel Indices of populations of these patients can average over 60 and even better in younger patients. More controversial remains the role of this procedure in dominant hemispheric infarcts. At MGH, we have, in carefully selected patients (younger, with incomplete aphasia) have proceeded with dominant hemisphere decompression. As more experience is gained with the procedure, we will further sort out those populations where most benefit is observed. ~Bob Carter, M.D.