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decompressive hemicraniectomy

Soumik Das, Arun Kumar Gupta, Arvinda Hanumathapura Ramalingiah
We report here a rare complication in the form of kinking of flow diverter in a case of giant wide-necked supraclinoid internal carotid artery (ICA) aneurysm 48 hours after the procedure. This 28-year female presented with giant wide-necked right supraclinoid ICA aneurysm which was managed by flow diversion. On 2nd post-op day, patient developed weakness of left side with altered sensorium - angiography and CT showed kinking of flow diverter at the neck of the aneurysm with poor distal flow. Eventually, the patient developed right middle cerebral artery infarct for which decompressive hemicraniectomy was done...
March 2018: Neurointervention
Luke Mugge, Tarek R Mansour, Brianna Krafcik, Travis Mazur, Tonya Floyd-Bradstock, Azedine Medhkour
Stroke is one of the leading causes of mortality and morbidity worldwide and requires rapid and intensive treatment to prevent adverse outcomes. Decompressive hemicraniectomy stands as the gold standard for surgical resolution of the intracranial swelling which accompanies cerebral infarction; however, the benefits of this procedure are not as well achieved in the elderly (age >65 yoa) compared to the younger population. This is a critical review performed on all available literature relating to middle cerebral artery (MCA) stroke in the elderly with emphasis on articles examining causality of adverse outcomes in this group over younger populations...
March 8, 2018: Journal of Neurosurgical Sciences
Saadat Kamran, Abdul Salam, Naveed Akhtar, Ayman Alboudi, Kainat Kamran, Rajvir Singh, Numan Amir, Jihad Inshasi, Uwais Qidwai, Rayaz A Malik, Ashfaq Shuaib
In patients with malignant middle cerebral artery (MMCA) stroke, a vital clinically relevant question is determination of the speed with which infarction evolves to select the time for decompressive hemicraniectomy [DHC]. A retrospective, multicenter cross-sectional study of patients referred for DHC, based on the criteria of randomized controlled trials, was undertaken to identify factors for selecting the timing of DHC in MMCA stroke, stratified by time [< 48, 48-72, > 72 h]. Infarction volume and infarct growth rate [IGR] were measured on all CT scans...
March 6, 2018: Translational Stroke Research
Byoung-Joon Kim, Yeon Ran Hong, Youngmin Han, Yang-Ha Hwang, Boram Ohk, Jaechan Park
OBJECTIVE: To improve the process of surgical informed consent, patient attitudes towards acceptable levels of disability after decompressive surgery for malignant middle cerebral artery infarction are investigated, including the impact of patient age. METHODS: Patients who had experienced a recent minor stroke were asked to complete a questionnaire comprised of 2 parts: 1) demographic information, including patient age, gender, years of education, working status, religion, and economic status and 2) acceptable level of disability based on a modified Rankin Scale (mRS) with corresponding illustrations to explain the mRS levels...
February 16, 2018: World Neurosurgery
Won Joo Jeong, Jae Seung Bang, Kyu Sun Yum, Sangkil Lee, Inyoung Chung, O-Ki Kwon, Chang Wan Oh, Beom Joon Kim, Hee-Joon Bae, Moon-Ku Han
Brain herniation is most often the result of severe brain swelling and can rapidly lead to death or brain death. We retrospectively identified radiologic indicators to evaluate the effects of targeted temperature management (TTM) on the extent of cerebral edema and determine the cutoff values that best predict TTM outcomes in patients with large hemispheric infarction. We retrospectively reviewed brain computed tomography (CT) scans of 21 patients with large hemispheric infarctions, who were treated with TTM...
February 15, 2018: Therapeutic Hypothermia and Temperature Management
Daniel Azzam, Prasanth Romiyo, Thien Nguyen, John P Sheppard, Yasmine Alkhalid, Carlito Lagman, Giyarpuram N Prashant, Isaac Yang
OBJECTIVE: Duraplasty, a common neurosurgical intervention, involves synthetic or biological graft placement to ensure dural closure. The objective of this study is to advance our understanding of the use of dural substitutes in cranial surgery. METHODS: The PubMed database was systematically searched to identify studies published over the last decade (2007 to 2017) that described duraplasty procedures. Clinical data were disaggregated and analyzed for the comparisons of biological versus synthetic grafts...
January 25, 2018: World Neurosurgery
Prakash Paliwal, Farasat Kazmi, Hock Luen Teoh, Leonard L L Yeo, Raymond C S Seet, Tseng Tsai Yeo, Lwin Sein, Ning Chou, Thomas Tan, Bernard P L Chan, Vijay K Sharma
INTRODUCTION: Early decompression craniectomy (within 48 hours of stroke onset) in acute and malignant middle cerebral artery (MCA) ischemic stroke (IS) reduces mortality and increases the proportion of patients with favorable functional outcome. Various cultural and social issues among Asians lead to some differences in clinical practice, especially when surgical interventions are involved. Accordingly, decompressive craniectomy in Asian patients with stroke is often delayed. MATERIALS AND METHODS: Data for all patients with acute IS hospitalized in our center were entered into a prospectively maintained registry...
January 6, 2018: World Neurosurgery
Yuchun Liu, Keqin Li, Yi Huang, Jie Sun, Xiang Gao
RATIONALE: The superior sagittal sinus (SSS) and transverse sinus are the major dural sinuses that receive a considerable amount of venous drainage. The occlusion of them has been suggested to cause intracranial hypertension, hemorrhage, and lead to potentially fatal consequences. PATIENT CONCERNS: We reported a 35-year-old woman with headache presented to our emergency department with a decreased level of consciousness and epileptic seizures. The examination of speech, higher mental function, and cranial nerve were normal...
December 2017: Medicine (Baltimore)
Jan Rahmig, Matthias Kuhn, Hermann Neugebauer, Eric Jüttler, Heinz Reichmann, Hauke Schneider
BACKGROUND: Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment. METHODS: We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol...
December 4, 2017: BMC Neurology
Nina Paletta, Laith Maali, Abdurrehman Zahran, Sankara Sethuraman, Ramon Figueroa, Fenwick T Nichols, Askiel Bruno
BACKGROUND AND PURPOSE: A standardized and validated method to measure brain shifts in malignant middle cerebral artery (MCA) stroke with decompressive hemicraniectomy (DHC) could facilitate clinical decision making, prognostication, and comparison of results between studies. METHODS: We tested for reliability simplified methods to measure transcalvarial herniation, midline brain shift, and the contralateral cerebral ventricular atrium in malignant MCA stroke after DHC...
November 10, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Archana Hinduja, Rohan Samant, Dongxia Feng, Yousef Hannawi
BACKGROUND: Despite decompressive hemicraniectomy (DHC), progressive herniation resulting in death has been reported following middle cerebral artery (MCA) strokes. We aimed to determine the surgical parameters measured on brain computed tomography (CT) scan that are associated with progressive herniation despite DHC in large MCA strokes. METHODS: Retrospective chart review of medical records of patients with malignant hemispheric infarction who underwent DHC for cerebral edema was performed...
October 26, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Magnus Olivecrona, Stephen Honeybul
BACKGROUND: Decompressive hemicraniectomy (DC) is an established lifesaving treatment for malignant infarction of the middle cerebral artery (mMCAI). However, surgical decompression will not reverse the effects of the stroke and many survivors will be left severely disabled. The objective of this study was to assess what neurological outcome would be considered acceptable in these circumstances amongst Swedish healthcare workers. METHOD: Healthcare workers were invited to participate in a presentation that outlined the pathophysiology of mMCAI, the rationale behind DC and outcome data from randomised controlled trials that have investigated efficacy of the procedure...
January 2018: Acta Neurochirurgica
Sven Kürten, Christopher Munoz, Kerim Beseoglu, Igor Fischer, Jason Perrin, Hans-Jakob Steiger
BACKGROUND: According to current evidence, adding decompressive craniectomy (DC) to best medical therapy reduces case fatality rate of malignant middle cerebral artery infarction by 50-75%. There is currently little information available regarding the outcome of subgroups, in particular of patients with extensive infarctions exceeding the territory of the middle cerebral artery. METHODS: The records of 101 patients with large hemispheric infarctions undergoing DC were retrospectively reviewed...
January 2018: Acta Neurochirurgica
Rami James N Aoun, Aman Gupta, Matthew E Welz, Bernard R Bendok
No abstract text is available yet for this article.
July 1, 2017: Neurosurgery
Sudip Kumar Sengupta
No abstract text is available yet for this article.
September 2017: World Neurosurgery
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
December 2017: Anesthesia and Analgesia
Saadat Kamran, Naveed Akhtar, Ayman Alboudi, Kainat Kamran, Arsalan Ahmad, Jihad Inshasi, Abdul Salam, Ashfaq Shuaib, Uvais Qidwai
The prediction of infarction volume after stroke onset depends on the shape of the growth dynamics of the infarction. To understand growth patterns that predict lesion volume changes, we studied currently available models described in literature and compared the models with Adaptive Neuro-Fuzzy Inference System [ANFIS], a method previously unused in the prediction of infarction growth and infarction volume (IV). We included 67 patients with malignant middle cerebral artery [MMCA] stroke who underwent decompressive hemicraniectomy...
August 8, 2017: Scientific Reports
Min Lang, Nina Z Moore, Alex M Witek, Varun R Kshettry, Mark D Bain
BACKGROUND: Patients with Moyamoya or other intracranial steno-occlusive disease are at risk for developing aneurysms associated with flow through collateral vessels. Because these lesions are rare, the optimal management remains unclear. Here, we describe 2 cases of microsurgical repair of ruptured collateral vessel aneurysms associated with middle cerebral artery (MCA) occlusion. CASE DESCRIPTION: The first patient was a 61-year-old man who presented with right frontal and intraventricular hemorrhage...
September 2017: World Neurosurgery
Saadat Kamran, Abdul Salam, Naveed Akhtar, Aymen Alboudi, Arsalan Ahmad, Rabia Khan, Rashed Nazir, Muhammad Nadeem, Jihad Inshasi, Ahmed ElSotouhy, Ghanim Al Sulaiti, Ashfaq Shuaib
OBJECTIVE: The purpose of this retrospective multicenter, pooled-data analysis was to determine the factors associated with in-hospital mortality in decompressive hemicraniectomy (DHC) for malignant middle cerebral artery (MMCA) stroke. PATIENTS AND METHODS: The authors reviewed pooled DHC database from 3 countries for patients with MMCA with hospital mortality in spite of DHC to identify factors that predicted in-hospital mortality after DHC. The identified factors were applied to the group of patients who were selected for DHC but either refused surgery and died or stabilized and did not undergo DHC...
September 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Haifa M Algethamy, Afnan Samman, Saleh S Baeesa, Mohammed A Almekhlafi, Yousef A Al Said, Ahmed Hassan
OBJECTIVE: To describe our experience implementing decompressive hemicraniectomy (DH) for eligible patients with malignant middle cerebral artery (MCA) infarcts. METHODS: We retrospectively collected data of malignant MCA infarction patients requiring DH at King Abdulaziz University Hospital & King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia between October 2010 and July 2015. Clinical outcome was assessed immediately postoperatively using Glasgow Coma Score (GCS), and at 12 months using the modified Rankin scale (mRS) and Barthel index...
July 2017: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
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