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Table 4 Mortality data in patients with malignant middle cerebral artery infarction: studies with comparative data on conservative treatment versus decompressive surgery

From: Clinical review: Therapy for refractory intracranial hypertension in ischaemic stroke

Authors Patients treated with conservative treatment Patients treated with decompressive surgery Mean age (years) Mortality in hospital Mortality up to 3 months Mortality up to 6 months Mortality up to 12 months
Delashaw et al., 1990 [118]a 4 9 NA vs. 57 100% vs. 0% 100% vs. 11% 100% vs. NA 100% vs. NA
Steiger 1991 [119]b 7 8 NA 100% vs. 25% 100% vs. 25% 100% vs. 25% NA
Rieke et al., 1995 [77], Hacke et al., 1996 [3], Wirtz et al., 1997 [104], Schwab et al., 1998 [109]c 55 63 56 vs. 50 78% vs. 25% NA vs. 25% NA NA
Holtkamp et al., 2001 [114]d 12 12 73 vs. 65 83% vs. 17% 83% vs. 25% 83% vs. 25% 83% vs. 33%
Mori et al., 2001 [120] 15 19 72 vs. 63 60% vs. 11% 67% vs. 16% NA NA
Mori et al., 2004 [111]e 15 19 72 vs. 65 62% vs. 12% NA 71% vs. 24% NA
Kuroki et al., 2001 [121]f 7 8 80 vs. 72 86% vs. 13% NA NA NA
Cho et al., 2003 [115]g 10 42 64 vs. 63 80% vs. 29% NA NA NA
Maramattom et al., 2004 [116]h 10 14 63 vs. 55 60% vs. 0% NA NA NA
Yang et al., 2005 [122]i 14 10 66 vs. 59 64% vs. 10% 64% vs. 10% NA NA
Wang et al., 2006 [117]j 41 21 67 vs. 62 NA NA 22% vs. 29% NA
Authors Patients treated with hypothermia Patients treated with decompressive surgery Mean age (years) Mortality in hospital Mortality up to 3 months Mortality up to 6 months Mortality up to 12 months
Georgiadis et al., 2002 [124] 19 17 56 vs. 52 47% vs. 12% NA NA NA
Authors Patients treated with decompressive surgery + hypothermia Patients treated with decompressive surgery Mean age (years) Mortality in hospital Mortality up to 3 months Mortality up to 6 months Mortality up to 12 months
Els et al., 2006 [125]k 12 13 49 vs. 49 8% vs. 15% 8% vs. 15% 8% vs. 15% NA
  1. aNot randomised. All four patients in the nonintervention group had a dominant MCA infarction, and all nine patients in the intervention group had a nondominant MCA infarction.
  2. bNot randomised. All patients were younger than 60 years. There is a selection bias because conservatively treated patients were not regarded as being suitable for surgery.
  3. cNot randomised. These studies represent the largest case series in the literature using the case series of Hacke and colleagues (1996) [3] as historical control group. Mortality rates of early versus delayed surgery were 16% versus 34%.
  4. dNot randomised. There is a selection bias by advanced age and more comorbidity in conservatively treated patients. All patients were older than 55 and younger than 75 years.
  5. eNot randomised. There is a selection bias because treatment decision was based primarily on the consent by the patient's relatives. Some patients received internal decompression. Mortality rates of early versus late surgery were 19% versus 28%. The case series of 2004 included the patients of the case series of 2001.
  6. fNot randomised. The study used historical controls.
  7. gNot randomised. Mortality rates of ultra-early (<6 hours) versus delayed surgery were 8% versus 37%.
  8. hNot randomised. Hemicraniectomy was performed only in patients, who deteriorated clinically.
  9. iNot randomised.
  10. jNot randomised. There was no difference between late and early hemicraniectomies.
  11. kRandomised. Twelve patients received mild hypothermia (35°C) in addition to hemicraniectomy. In the group treated by hemicraniectomy alone more patients had a right-sided infarction and additional infarction of the ACA or PCA.
  12. ACA, anterior cerebral artery; NA, not available; PCA, posterior cerebral artery.