Abstract
Malignant middle cerebral infarction is defined as a clinicaldeterioration from hemispheric swelling and is named‘‘malignant’’ because it is rapidly injurious to the patient.Recommendations for early decompressive hemicraniec-tomy (DHC) in malignant middle cerebral artery infarction(mMCAI)intheclinicalroutineare based ondata fromthreeEuropean randomised controlled trials (DECIMAL, DE-compressive Craniectomy In MALignant middle cerebralartery infarcts [1]; DESTINY, DEcompressive Surgery forthe Treatment of malignant Infarction of the middle cerebralartery [2]; and HAMLET, Hemicraniectomy After Middlecerebral artery infarction with Life-threatening Edema Trial[3]) and two pooled meta-analyses [3, 4]. The results clearlydemonstrated that DHC is more than just an optional inter-vention in mMCAI as mortality was consistentlysignificantlylowerinpatientswho underwentsurgery acrossall three trials, as compared with controls. None of the trialsormeta-analyses were abletoshow significant improvementin functional outcome with DHC when the predefineddichotomization between a modified Rankin scale score(mRS) of 0–3 and 4–6 was used [3, 5]. However, a post hocmeta-analysis of the pooled data including totally 109patients indicates that early surgery ( 4 (6 months: 31.2 vs. 92.3 %; 1 year: 37.5 vs.100 %). Based on those findings, the authors come to theoptimistic conclusion that DHC is beneficial for patientsaged 61–80 years although there seems to be an increasedlikelihood for those patients to survive with moderatelysevere disability (mRS 4).As Zhao et al. state in the discussion of their article,those results are ‘‘exciting,’’ providing the first outcome
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.