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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Preliminary Results of Randomized Controlled Study on Decompressive Craniectomy in Treatment of Malignant Middle Cerebral Artery Stroke

1
Neurosurgery Clinic, Pauls Stradins Clinical University Hospital
2
Department of Science, Riga Eastern Clinical University Hospital
3
Neurology Clinic, Pauls Stradins Clinical University Hospital, Latvia
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Author to whom correspondence should be addressed.
Medicina 2012, 48(10), 76; https://doi.org/10.3390/medicina48100076
Received: 30 June 2012 / Accepted: 2 October 2012 / Published: 5 October 2012
Background and Objective. Studies on decompressive craniectomy (DCE) after a malignant middle cerebral artery (MCA) stroke in selected population show an increased probability of survival without increasing the number of very severely disabled. Cerebral infarct volume (CIV) as a triage criterion for performing surgery has not been discussed in literature. The aim of this study was to investigate the value of CIV and initial National Institutes of Health Stroke Scale (NIHHS) and Glasgow Coma Scale (GCS) scores as possible triage criteria in the surgical treatment of patients with “malignant” MCA stroke.
Material and Methods. According to the study protocol, 28 patients with a malignant MCA stroke were included and analyzed prospectively. The patients were randomly divided either into the DCE plus best medical treatment (BMT) group or BMT alone group. CIV and NIHHS and GCS scores were measured at time of enrollment in every case. Clinical outcome was evaluated 1 year after the treatment.
Results. Six patients survived: 5 in the DCE group (none of them was older than 60 years) and 1 in the BMT group (P=0.03/0.06). Among survivors, none had a cerebral infarct volume of more than 390 cm3 (P=0.05). All survivors in the DCE group had favorable outcomes. There was no significant difference in the NIHSS and GCS scores between the groups and survivors/nonsurvivors (P>0.05).
Conclusions. Decompressive surgery in the selected patients is likely to increase the probability of survival with a favorable outcome without increasing the number of severely disabled survivors. Patients with CIV of more than 390 cm3 may be bad candidates for DCE, and the prognosis is likely to be bad regardless the treatment strategy. The initial NIHHS and GCS scores did not prove any prognostic value in outcome.
Keywords: malignant middle cerebral artery stroke; decompressive craniectomy; space-occupying edema; clinical trial malignant middle cerebral artery stroke; decompressive craniectomy; space-occupying edema; clinical trial
MDPI and ACS Style

Slezins, J.; Keris, V.; Bricis, R.; Millers, A.; Valeinis, E.; Stukens, J.; Minibajeva, O. Preliminary Results of Randomized Controlled Study on Decompressive Craniectomy in Treatment of Malignant Middle Cerebral Artery Stroke. Medicina 2012, 48, 76.

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