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https://www.readbyqxmd.com/read/29651563/predictors-of-decompressive-hemicraniectomy-in-malignant-middle-cerebral-artery-stroke
#1
Saadat Kamran, Abdul Salam, Naveed Akhtar, Atlantic D'soza, Ashfaq Shuaib
Identification of factors in malignant middle cerebral artery (MMCA) stroke patients that may be useful in selecting patients for DHC. This study was a retrospective multicenter study of patients referred for DHC based on the criteria of the randomized control trials of DHC in MMCA stroke. Demographic, clinical, and radiology data were analyzed. Patients who underwent DHC were compared to those who survived without surgery. Two hundred three patients with MMCA strokes were identified: 137 underwent DHC, 47 survived without DHC, and 19 refused surgery and died...
April 12, 2018: Neurosurgical Review
https://www.readbyqxmd.com/read/29644406/the-wessex-modified-richmond-sedation-scale-as-a-novel-tool-for-monitoring-patients-at-risk-of-malignant-mca-syndrome
#2
Tayyib T A Hayat, Matthew A Myers, John Hell, Matthew Cordingly, Diederik O Bulters, Nicolas Weir, George Pengas
BACKGROUND: The Wessex Modified Richmond Sedation Scale (WMRSS) has been developed with the aim of improving the early identification of patients requiring decompressive hemicraniectomy for malignant middle cerebral artery syndrome (MMS). The objective of this study was to evaluate the WMRSS against the Glasgow Coma Scale (GCS). METHODS: A retrospective study was conducted of patients admitted to our unit for observation of MMS. Data were obtained on WMRSS and GCS recordings from admission up to 120-h post-ictus...
April 11, 2018: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29535900/kinking-of-flow-diverter-in-a-giant-wide-necked-supraclinoid-internal-carotid-artery-aneurysm
#3
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
https://www.readbyqxmd.com/read/29527887/immunological-vascular-metabolic-and-autonomic-changes-seen-with-aging-possible-implications-for-poor-outcomes-in-the-elderly-following-decompressive-hemicraniectomy-for-malignant-mca-stroke-a-critical-review
#4
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
https://www.readbyqxmd.com/read/29526071/safety-and-efficacy-of-hypothermia-34%C3%A2-c-after-hemicraniectomy-for-malignant-mca-infarction
#5
Hyun-Seok Park, Jae-Hyung Choi
OBJECTIVE: The beneficial effect of hypothermia after hemicraniectomy in malignant middle cerebral artery (MCA) infarction has been controversial. We aim to investigate the safety and clinical efficacy of hypothermia after hemicraniectomy in malignant MCA infarction. METHODS: From October 2012 to February 2016, 20 patients underwent hypothermia (Blanketrol III, Cincinnati Sub-Zero, Cincinnati, OH, USA) at 34°C after hemicraniectomy in malignant MCA infarction (hypothermia group)...
March 2018: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/29508233/factors-that-can-help-select-the-timing-for-decompressive-hemicraniectomy-for-malignant-mca-stroke
#6
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
https://www.readbyqxmd.com/read/29481497/single-piece-titanium-plate-cranioplasty-reconstruction-of-complex-defects
#7
Joseph Luo, David Anthony Morrison, Alex John Hayes, Arul Bala, Guy Watts
BACKGROUND: Different methods have been described for the reconstruction of cranial defects and orbital defects. The complex contouring between the orbital roof and frontal bone creates significant design challenges for prefabricated cranio-orbital reconstructions. In describing the first reported patient of combined skull and orbital roof reconstruction with a single-piece titanium plate cranioplasty, the authors present a new method of combined complex cranio-orbital reconstruction...
February 23, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29458183/age-dependent-attitudes-of-ischemic-patients-towards-disability-after-decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-infarction
#8
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
https://www.readbyqxmd.com/read/29447082/radiologic-measurement-of-brain-swelling-in-patients-with-large-hemispheric-infarctions-during-targeted-temperature-management
#9
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
https://www.readbyqxmd.com/read/29374609/dural-repair-in-cranial-surgery-is-associated-with-moderate-rates-of-complications-with-both-autologous-and-non-autologous-dural-substitutes
#10
REVIEW
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
https://www.readbyqxmd.com/read/29317364/early-decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-infarction-in-asian-patients-a-single-center-study
#11
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...
March 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29245300/treatment-of-the-superior-sagittal-sinus-and-transverse-sinus-thrombosis-associated-with-intracranial-hemorrhage-with-the-mechanical-thrombectomy-and-thrombolytics-case-report
#12
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)
https://www.readbyqxmd.com/read/29202815/normothermia-after-decompressive-surgery-for-space-occupying-middle-cerebral-artery-infarction-a-protocol-based-approach
#13
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
https://www.readbyqxmd.com/read/29124813/a-simplified-quantitative-method-to-measure-brain-shifts-in-patients-with-middle-cerebral-artery-stroke
#14
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...
January 2018: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/29107638/herniation-despite-decompressive-hemicraniectomy-in-large-hemispherical-ischemic-strokes
#15
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...
February 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29103136/a-study-of-the-opinions-of-swedish-healthcare-personnel-regarding-acceptable-outcome-following-decompressive-hemicraniectomy-for-ischaemic-stroke
#16
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
https://www.readbyqxmd.com/read/29079663/favorable-revascularization-therapy-in-patients-with-aspects-%C3%A2-5-on-dwi-in-anterior-circulation-stroke
#17
Isabelle Mourand, Eitan Abergel, Daniel Mantilla, Xavier Ayrignac, Tzvika Sacagiu, Omer Faruk Eker, Gregory Gascou, Cyril Dargazanli, Carlos Riquelme, Marinette Moynier, Alain Bonafé, Caroline Arquizan, Vincent Costalat
BACKGROUND: A low baseline Alberta Stroke Programme Early CT Score (ASPECTS) is strongly associated with low rates of favorable outcome in patients with acute stroke. OBJECTIVE: To evaluate the efficacy and safety of revascularization therapy in patient with ASPECTS ≤5 in anterior circulation infarct. METHODS: We retrospectively analyzed 108 consecutive patients presenting low ASPECTS on diffusion-weighted imaging. Sixty patients were treated by mechanical thrombectomy, including 34 patients who received simultaneously intravenous thrombolysis...
January 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28965156/decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-infarction-including-patients-with-additional-involvement-of-the-anterior-and-or-posterior-cerebral-artery-territory-outcome-analysis-and-definition-of-prognostic-factors
#18
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
https://www.readbyqxmd.com/read/28887767/management-of-spontaneous-intracerebral-hemorrhage
#19
REVIEW
Roland Veltkamp, Jan Purrucker
PURPOSE OF REVIEW: We review the current evidence for medical and surgical treatments of spontaneous intracerebral hemorrhage (ICH). RECENT FINDINGS: Therapy with hemostatic agents (e.g. factor VIIa and tranexamic acid) if started early after bleeding onset may reduce hematoma expansion, but their clinical effectiveness has not been shown. Rapid anticoagulation reversal with prothrombin concentrates (PCC) plus vitamin K is the first choice in vitamin K antagonist-related ICH...
September 8, 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28885045/duret-hemorrhage-complicating-a-sinking-skin-flap-syndrome
#20
Mickael Cardinale, Eric Meaudre, Pierre-Julien Cungi, Cédric Nguyen, Pierre Esnault, Christophe Joubert
Duret hemorrhage has always been reported during an episode of increased intracranial pressure with transtentorial herniation. We reported a Duret hemorrhage occurring during an episode of intracranial hypotension resulted in sinking skin flap syndrome which was responsible for acute paradoxal descending transtentorial herniation and Duret hemorrhage, 10 days after large hemicraniectomy which could indicate early cranioplasty.
September 8, 2017: British Journal of Neurosurgery
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