Volume 11 Supplement 3

Fourth International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Hemicraniectomy for large middle cerebral artery territory infarction: outcome and clinical variables in 10 patients

  • SVC da Silva1,
  • FS Machado2,
  • AC Neto1,
  • AC Feraz1,
  • RD Morsch1 and
  • AL Baptiston Nunes2
Critical Care200711(Suppl 3):P76

https://doi.org/10.1186/cc5863

Published: 19 June 2007

Background

Historically, large space-occupying middle cerebral artery (MCA) infarction carries a mortality of 50–80%. Several studies have shown that decompressive hemicraniectomy can decrease mortality, morbidity and improve functional outcome, especially in younger patients. Other important variables are the time of decompressive hemicraniectomy and the severity of neurologic damage.

Methods

A retrospective review of clinical variables of 10 patients who underwent decompressive craniectomy for space-occupying MCA infarction, from July 2002 to October 2003. Clinical outcome was evaluated using the Glasgow Outcome Scale (GOS). Statistical analysis was performed by chi-square and proportion analysis.

Results

There were seven males and three females with a mean age of 56.6 years (range 38–73 years). The time between hospital admission and craniectomy was 4 days (range 1–13 days). The duration of orotracheal intubation was 8 days (range 5–12 days). The length of stay in the ICU was 14 days (range 8–22 days). Five patients were submitted to hypothermia and four used thiopental. GOS scores at 6 months were: one patient with GOS 1; three patients with GOS 3; four patients with GOS 4; and two patients with GOS 5.

Conclusion

This small group showed low mortality and good functional outcome. Age was the unique variable associated with a good outcome.
Table 1

Clinical variables

 

GOS 4–5

GOS 1–3

Total

P

Patients

6 (60%)

4 (40%)

10

0.97

Age (average)

47 (8.3)

70.75 (3.2)

 

<0.006

Male

5

2

7

 

Female

1

2

3

 

Glasgow at admission

9 to 12

6 to 11

 

0.22

Herniation

1

1

2

 

Absence of herniation

5

3

8

 

Territory (right MCA)

4

1

5

0.78

Territory (left MCA)

1

3

4

 

Craniectomy performed

4

2

3

0.52

   <48 hours

    

Craniectomy performed

2

2

4

 

   >48 hours

    

Hypothermia

4

1

5

0.52

Normothermia

2

3

5

 

Thiopental (+)

3

1

 

0.50

Thiopental (+)

3

3

  

Noradrenaline (+)

5

3

 

1.0

Noradrenaline (-)

1

1

  

Authors’ Affiliations

(1)
Hospital Israelita Albert Einstein
(2)
Hospital e Maternidade São Camilo Santana

Copyright

© BioMed Central Ltd 2007

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