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Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery.

Lu X, Huang B, Zheng J, Tao Y, Yu W, Tang L, Zhu R, Li S, Li L - Sci Rep (2014)

Bottom Line: The results demonstrated that early DC (within 48 h after stroke onset) decreased mortality (OR = 0.14, 95%CI = 0.08, 0.25, p<0.0001) and number of patients with poor functional outcome (modified Rankin scale (mRS)>3) (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004) for 12 months follow-up.In the subgroup analysis stratified by age, early DC improved outcome both in younger and older patients.However, later DC (after 48h after stroke onset) might not have a benefit effect on lowering mortality or improving outcome in patients with malignant infarction.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.

ABSTRACT
Early decompressive craniectomy (DC) has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction, whereas efficacy of DC on functional outcome is inconclusive. Here, we performed a meta-analysis to estimate the effects of DC on malignant MCA infarction and investigated whether age of patients and timing of surgery influenced the efficacy. We systematically searched PubMed, Medline, Embase, Cochrane library, Web of Science update to June 2014. Finally, A total of 14 studies involved 747 patients were included, of which 8 were RCTs (341 patients). The results demonstrated that early DC (within 48 h after stroke onset) decreased mortality (OR = 0.14, 95%CI = 0.08, 0.25, p<0.0001) and number of patients with poor functional outcome (modified Rankin scale (mRS)>3) (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004) for 12 months follow-up. In the subgroup analysis stratified by age, early DC improved outcome both in younger and older patients. However, later DC (after 48h after stroke onset) might not have a benefit effect on lowering mortality or improving outcome in patients with malignant infarction. Together, this study suggested that decompressive surgery undertaken within 48 h reduced mortality and increased the number of patients with a favourable outcome in patients with malignant MCA infarction.

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Related in: MedlinePlus

Flow chart of the literature search.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4233335&req=5

f1: Flow chart of the literature search.

Mentions: A diagram summarizing the process of study selection is shown in Figure 1. The combined search yielded 1998 citations, of which 1978 were excluded by review of titles and abstracts, because they were reviews, case reports, letters to editor, comments, and duplicate studies. Further, full texts of the remaining 20 articles were reviewed and analyzed in detail. Eventually, 14 studies met our inclusion criteria, comprising of 349 patients in the surgical treatment group and 398 patients in the conservative group. Of which, eight studies (341 patients) were RCTs1314161718192021, 4 (286 patients) were retrospective studies and 2 (120 patients) were prospective studies222324252627, The main characteristics of the studies included in this meta-analysis are summarized in Table 1.


Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery.

Lu X, Huang B, Zheng J, Tao Y, Yu W, Tang L, Zhu R, Li S, Li L - Sci Rep (2014)

Flow chart of the literature search.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233335&req=5

f1: Flow chart of the literature search.
Mentions: A diagram summarizing the process of study selection is shown in Figure 1. The combined search yielded 1998 citations, of which 1978 were excluded by review of titles and abstracts, because they were reviews, case reports, letters to editor, comments, and duplicate studies. Further, full texts of the remaining 20 articles were reviewed and analyzed in detail. Eventually, 14 studies met our inclusion criteria, comprising of 349 patients in the surgical treatment group and 398 patients in the conservative group. Of which, eight studies (341 patients) were RCTs1314161718192021, 4 (286 patients) were retrospective studies and 2 (120 patients) were prospective studies222324252627, The main characteristics of the studies included in this meta-analysis are summarized in Table 1.

Bottom Line: The results demonstrated that early DC (within 48 h after stroke onset) decreased mortality (OR = 0.14, 95%CI = 0.08, 0.25, p<0.0001) and number of patients with poor functional outcome (modified Rankin scale (mRS)>3) (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004) for 12 months follow-up.In the subgroup analysis stratified by age, early DC improved outcome both in younger and older patients.However, later DC (after 48h after stroke onset) might not have a benefit effect on lowering mortality or improving outcome in patients with malignant infarction.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.

ABSTRACT
Early decompressive craniectomy (DC) has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction, whereas efficacy of DC on functional outcome is inconclusive. Here, we performed a meta-analysis to estimate the effects of DC on malignant MCA infarction and investigated whether age of patients and timing of surgery influenced the efficacy. We systematically searched PubMed, Medline, Embase, Cochrane library, Web of Science update to June 2014. Finally, A total of 14 studies involved 747 patients were included, of which 8 were RCTs (341 patients). The results demonstrated that early DC (within 48 h after stroke onset) decreased mortality (OR = 0.14, 95%CI = 0.08, 0.25, p<0.0001) and number of patients with poor functional outcome (modified Rankin scale (mRS)>3) (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004) for 12 months follow-up. In the subgroup analysis stratified by age, early DC improved outcome both in younger and older patients. However, later DC (after 48h after stroke onset) might not have a benefit effect on lowering mortality or improving outcome in patients with malignant infarction. Together, this study suggested that decompressive surgery undertaken within 48 h reduced mortality and increased the number of patients with a favourable outcome in patients with malignant MCA infarction.

Show MeSH
Related in: MedlinePlus