Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke

• Main Authors: Isaac Holanda Mendes MAIA, Thaissa Pinto de MELO, Fabrício Oliveira LIMA, João José de Freitas CARVALHO, Francisco José Arruda MONT’ALVERNE, Edson LOPES JÚNIOR, Marcelo Bezerra DIÓGENES, Thaís Saraiva Leão CUNHA, Bárbara Matos Almeida QUEIROZ, Marina Franciss TAMIETTI, Fernanda Martins MAIA
• Format: Article
• Language: English
• Published: Academia Brasileira de Neurologia (ABNEURO)
• Series: Arquivos de Neuro-Psiquiatria
• Subjects: acidente vascular cerebral; edema encefálico; craniectomia descompressiva
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020005011206&lng=en&tlng=en

ABSTRACT Background: Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. Objective: To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. Methods: Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. Results: A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). Conclusion: In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability.