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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

Forest plot with OR estimating with the corresponding 95% CI for unfavourable outcome (defined as mRS>3) associated with early DC versus medical treatment for individual trials and the pooled population at 3 months, 6 months, 12 months and 36 months follow-up (patients in all ages) CI, confidence interval; DC: decompressive craniectomy; OR, odds ratio; mRS: modified Rankin scale.
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f3: Forest plot with OR estimating with the corresponding 95% CI for unfavourable outcome (defined as mRS>3) associated with early DC versus medical treatment for individual trials and the pooled population at 3 months, 6 months, 12 months and 36 months follow-up (patients in all ages) CI, confidence interval; DC: decompressive craniectomy; OR, odds ratio; mRS: modified Rankin scale.

Mentions: The proportion of patients with poor neurological outcome (defined as mRS>3) was reported for 3-month follow-up in 3 studies, 6 months follow-up in 8 studies, 12 months follow-up in 6 studies, and 36 months follow up in 1 study. The results indicated decompressive surgery significantly decreased number of patients with a poor outcome for 3 months follow up (OR = 0.1, 95%CI = 0.02, 0.48, p = 0.004), 6 months follow-up (OR = 0.34, 95%CI = 0.20, 0.59, p = 0.0001), and 12 months follow-up (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004), but not for 36 months follow-up (OR = 0.91, 95%CI = 0.20, 4.09). (Figure 3 and Table 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)

Forest plot with OR estimating with the corresponding 95% CI for unfavourable outcome (defined as mRS>3) associated with early DC versus medical treatment for individual trials and the pooled population at 3 months, 6 months, 12 months and 36 months follow-up (patients in all ages) CI, confidence interval; DC: decompressive craniectomy; OR, odds ratio; mRS: modified Rankin scale.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3: Forest plot with OR estimating with the corresponding 95% CI for unfavourable outcome (defined as mRS>3) associated with early DC versus medical treatment for individual trials and the pooled population at 3 months, 6 months, 12 months and 36 months follow-up (patients in all ages) CI, confidence interval; DC: decompressive craniectomy; OR, odds ratio; mRS: modified Rankin scale.
Mentions: The proportion of patients with poor neurological outcome (defined as mRS>3) was reported for 3-month follow-up in 3 studies, 6 months follow-up in 8 studies, 12 months follow-up in 6 studies, and 36 months follow up in 1 study. The results indicated decompressive surgery significantly decreased number of patients with a poor outcome for 3 months follow up (OR = 0.1, 95%CI = 0.02, 0.48, p = 0.004), 6 months follow-up (OR = 0.34, 95%CI = 0.20, 0.59, p = 0.0001), and 12 months follow-up (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004), but not for 36 months follow-up (OR = 0.91, 95%CI = 0.20, 4.09). (Figure 3 and Table 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