Decompressive craniectomy in malignant MCA infarction in times of mechanical thrombectomy
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ORIGINAL ARTICLE - NEUROSURGICAL INTENSIVE CARE
Decompressive craniectomy in malignant MCA infarction in times of mechanical thrombectomy Jennifer Göttsche 1 & Fabian Flottmann 2 & Larissa Jank 2 & Götz Thomalla 3 & David Leander Rimmele 3 & Patrick Czorlich 1 & Manfred Westphal 1 & Jan Regelsberger 1 Received: 12 October 2019 / Accepted: 12 December 2019 # Springer-Verlag GmbH Austria, part of Springer Nature 2019
Abstract Background Mechanical thrombectomies (MT) in stroke have changed the standard treatment regimen with a continuous increase of MTs during the last years. A subsequent reduction in the rates of decompressive craniectomies (DC) as well as a change in clinical characteristics of patients undergoing an additional DC after MT may be assumed. Therefore, objective of this study was to investigate the influence of nowadays regularly performed MT on patients undergoing DC. Methods Patients with DC due to cerebral infarctions between January 2009 and January 2018 were included. Patients’ clinical presentation and surgical parameters were collected retrospectively. Initial GCS and NIHSS, extent of the stroke, time interval from symptom onset to DC, and neurological outcome were compared between patients with and without thrombectomy. Results A total of 5469 ischemic strokes were treated in the investigated period, leading to DC in 119 cases (2.2%). A decrease in the rate of performed DCs was recorded: in 2009, 2.8% of ischemic stroke patients underwent surgery compared to 1.9% in 2017. In the meantime, the number of MTs in our center has increased from 84 in 2014 to 160 in 2017. MT was performed in 32 patients prior to DC. No significant differences could be seen between the groups regarding age, initial NIHSS (median 18 in both groups, p = 0.81), extent of the infarctions prior to DC (median ASPECTS 0 in both groups, p = 0.87), time interval from symptom onset to DC, and neurological outcome. Conclusions The introduction of routinely performed MT as part of the standard treatment regimen for ischemic stroke has led to a decrease in DCs. However, DC patients with and without MTshowed no differences regarding their initial clinical criteria and outcome. These results suggest that earlier DC studies in patients with MCA infarction also apply for the collective of thrombectomized patients. Keywords Decompressive craniectomy . Stroke . Thrombectomy . Neurocritical care
Introduction Decompressive craniectomy (DC) is a well-established neurosurgical intervention in patients suffering from malignant This article is part of the Topical Collection on Neurosurgical intensive care * Jennifer Göttsche [email protected] 1
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
2
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
3
Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
infarction of the
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