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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

Risk of bias assessment for randomized controlled trials.‘+': low risk of bias, ‘−': high risk of bias, and ‘?': Indicates unclear risk of bias.
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Related In: Results  -  Collection

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f2: Risk of bias assessment for randomized controlled trials.‘+': low risk of bias, ‘−': high risk of bias, and ‘?': Indicates unclear risk of bias.

Mentions: Quality assessments for RCTs and cohort studies were summarized in the Supplementary Table S1–S2 and Figure 2. Briefly, for RCTs, randomization methods were described in 3 studies131719 and allocation concealments were adequate in 2 studies1421. For blinding, 6 studies used blind observers to assess outcome, while blinded for carers or patients were unlikely in all RCTs. In addition, 2 studies reported the follow-up rates as 1001321%, which were not mentioned in other studies. Finally, none study had selective outcome reporting. (Figure 2) For cohort studies, the results of quality assessment showed that all six studies had a moderate risk of bias and reached 6–7 out of 9 points. (Supplementary Table S1 and 2)


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)

Risk of bias assessment for randomized controlled trials.‘+': low risk of bias, ‘−': high risk of bias, and ‘?': Indicates unclear risk of bias.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2: Risk of bias assessment for randomized controlled trials.‘+': low risk of bias, ‘−': high risk of bias, and ‘?': Indicates unclear risk of bias.
Mentions: Quality assessments for RCTs and cohort studies were summarized in the Supplementary Table S1–S2 and Figure 2. Briefly, for RCTs, randomization methods were described in 3 studies131719 and allocation concealments were adequate in 2 studies1421. For blinding, 6 studies used blind observers to assess outcome, while blinded for carers or patients were unlikely in all RCTs. In addition, 2 studies reported the follow-up rates as 1001321%, which were not mentioned in other studies. Finally, none study had selective outcome reporting. (Figure 2) For cohort studies, the results of quality assessment showed that all six studies had a moderate risk of bias and reached 6–7 out of 9 points. (Supplementary Table S1 and 2)

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