DECOMPRESSIVE CRANIOTOMY IN MANAGEMENT OF ACUTE CEREBRAL ISCHEMIA

Abstract

Background: Ischemic stroke is a medical emergency and the most common affection of the central nervous system (CNS). This is the second-leading cause of death worldwide and the first causes of morbidity. Ischemic stroke correspond to 85% of all strokes with a mortality of 10-50%. Large space-occupying infarction accounts for 1-10% of all supratentorial infarction with signs of elevated intracranial pressure (ICP) and brain herniation usually in the second to the fifth day leading to a mortality rate of 53% to 89%. Objective: To evaluate the clinical and radiological outcome of decompressive surgery in the setting of cerebral infarctions, and to study its effect in reducing the overall mortality rates of this fatal condition. Patients and methods: This study is descriptive and analytic clinical trial study for evaluating the clinical and functional outcomes of surgical cases with massive cerebral infarction. Over one year, Between January 2018 and January 2019, at Dar Alshifa Hospital, and Al-Azhar University Hospitals in Cairo. Results: Twenty cases with cerebral infarctions were included in this. In our study, there was 12 males (60%) and 8 females (40%) male: female ratio 1.5:1.The age of the cases ranged from 37 to 77 years. The mean age was 57.65 years. Four cases were less than 50 years (20%), 6 cases between 50 and 60 years (30%), 8 cases between 60 and 70 years (40%), and 2 cases above 70 years (10%). Eighteen cases had middle cerebral artery (MCA) infarctions (90/%), while 2 cases had both MCA and anterior cerebral artery (ACA) infarctions. eleven cases were right sided while 9 cases were having left-sided infarctions. Conclusion: The preoperative clinical condition , higher GCS score at presentation were strongly related to a favorable clinical outcome .Some ICU related complications such as contra lateral infarction, hemorrhagic infarction, pulmonary embolism, pneumonia can worse the patient outcome .Other complication related to the surgery such as CSF leak, wound infection did not effect on patient prognosis. Factors like patients’ age, sex, site of infarction, and preoperative midline shift did not affect the final outcome. A study with larger sample size and longer follow-up is recommended for better confirmation of these facts.