Decompressive hemicranectomy in patients with extensive ischemic stroke discussion issues about a series of cases

Abstract

Introduction: near 10% of the patients with stroke have a complete occlusion of the middle cerebral artery (MCA), generating a mortality that can reach 80% of the cases. The descompressive craniotomy (DC) can dramatically reduce mortality in these patients. Nevertheless it reminds unclear its paper in the impact on the patients neurological functionality.
Objective: to describe the considerations for the realization or not of DC and to analyze the clinical evolution and its neurological status at the hospitalization discharge.
Materials and methods: descriptive analysis of the patients taken care of in the Heart Institute of the Cardiovascular foundation of Colombia in the last 2 years with diagnosis of extensive stroke, dividing them in two groups, a group with DC and another one with conventional treatment.
Results: we collect 18 patients with extensive stroke, which 7 (38,8%) was made DC and 11 (61,1%) was gave conventional medical treatment. The etiology of the stroke most frequent in both groups was cardioembolism (61%). There were no differences of the stroke severity measured by NIHSS scale. All of the DC was made in the first 48 hours. The mortality in the group with DC was 14,2% while in the group with conventional treatment was 54,5%. The functionality at the hospitalization discharge shows a lower compromised in the DC group compared with the conventional treatment group (Rankin-m p=0,08 y Barthel p=0,03).
Conclusion: the DC is an alternative intervention for the patients with extensive stroke, whose primary target is to diminish mortality and to avoid the lesion of the contralateral hemisphere.