Outcome of decompressive hemi-craniectomy in patients with ischemic stroke at three-month follow-up

Abstract

One of the major complications of stroke among patients is the occurrence of brain edema. Given the high mortality of patients with drug-induced brain edema, study of the success rate and outcome of decompressive hemi craniotomy can be used as a first-line treatment in these patients if desired. Materials and Methods: All patients with ischemic stroke referred to Imam Reza Medical Center since June 2016 for two years who have had brain edema and have not responded to medication with mannitol or hypertonic saline and hyperventilation. Decompressive hemi-craniectomy surgery was followed for 3 months postoperatively in terms of mortality and severity of disability (based on MRS and NIHSS) during referral to the clinic. Similar patients who did not respond to drug treatment and did not consent to decompressive hemi-craniotomy surgery were included in the study. Patients' information was entered into a pre-prepared checklist. The checklist includes information such as age, sex, time of onset of symptoms, time of hospitalization, neurosurgery consultation, time of surgery, type of stroke, MRS (baseline, 3 months discharge), NIHSS (baseline, 3 months discharge). Next), site of infarction, GCS, vital signs, disease history, imaging findings, etiology and tPA intake. Then, checklist information was entered into SPSS v20 statistical analysis software and analyzed. Results: In this study, 50 patients with stroke were divided into two groups of 34 patients with surgery and 16 patients with follow-up. This study showed that at the time of discharge, MRS and NIHSS levels were significantly lower in the surgical group than in the other group, but three months later, no differences were found in these variables (MRS, NIHSS and GCS). There was also a significant decrease in the MRS level in the surgical group at three months follow-up. In the zero to 3 month mortality study, it was observed that decompressive hemi-craniectomy was able to significantly reduce the mortality rate within 3 months of onset of symptoms.