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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

Funnel plot to detect publication bias.No significant funnel asymmetry was observed which could indicate publication bias. (P value for Egger test was 0.38) logor Natural logarithm of the OR, s.e. of logor standard error of the logOR.
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f6: Funnel plot to detect publication bias.No significant funnel asymmetry was observed which could indicate publication bias. (P value for Egger test was 0.38) logor Natural logarithm of the OR, s.e. of logor standard error of the logOR.

Mentions: Publication bias was assessed by funnel plots and Egger's test. The shape of funnel plot did not reveal evidence of obvious asymmetry. (Figure 6) Then, the Egger's test was used to provide statistical evidence of funnel plot symmetry, which did not show any evidence of publication bias (p>0.12 for all comparisons), indicating that our results are statistically robust.


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)

Funnel plot to detect publication bias.No significant funnel asymmetry was observed which could indicate publication bias. (P value for Egger test was 0.38) logor Natural logarithm of the OR, s.e. of logor standard error of the logOR.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f6: Funnel plot to detect publication bias.No significant funnel asymmetry was observed which could indicate publication bias. (P value for Egger test was 0.38) logor Natural logarithm of the OR, s.e. of logor standard error of the logOR.
Mentions: Publication bias was assessed by funnel plots and Egger's test. The shape of funnel plot did not reveal evidence of obvious asymmetry. (Figure 6) Then, the Egger's test was used to provide statistical evidence of funnel plot symmetry, which did not show any evidence of publication bias (p>0.12 for all comparisons), indicating that our results are statistically robust.

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