Subcortical Sparing Associated with Ambulatory Independence after Hemicraniectomy for Malignant Infarction

Abstract

Decompressive hemicraniectomy (DHC) is a life-saving 1 Vahedi K. Hofmeijer J. Juettler E. et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007; 6: 215-222 Abstract Full Text Full Text PDF PubMed Scopus (1209) Google Scholar and function-sparing 2 Reinink H. Juttler E. Hacke W. et al. Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials. JAMA Neurol. 2020; Google Scholar procedure for patients with malignant middle cerebral artery (MCA) infarction. Pooled estimates suggest that approximately 40% of patients achieve ambulatory independence after DHC, 1 Vahedi K. Hofmeijer J. Juettler E. et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007; 6: 215-222 Abstract Full Text Full Text PDF PubMed Scopus (1209) Google Scholar ,2 Reinink H. Juttler E. Hacke W. et al. Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials. JAMA Neurol. 2020; Google Scholar with age 3 Juttler E. Unterberg A. Woitzik J. et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014; 370: 1091-1100 Crossref PubMed Scopus (360) Google Scholar being the only clinical or radiologic feature found to influence the likelihood of achieving this outcome. 2 Reinink H. Juttler E. Hacke W. et al. Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials. JAMA Neurol. 2020; Google Scholar Subcortical infarctions have been shown to impair motor recovery and gait, 4 Jones P.S. Pomeroy V.M. Wang J. et al. Does stroke location predict walk speed response to gait rehabilitation?. Hum Brain Mapp. 2016; 37: 689-703 Crossref PubMed Scopus (36) Google Scholar ,5 Zhu L.L. Lindenberg R. Alexander M.P. Schlaug G. Lesion load of the corticospinal tract predicts motor impairment in chronic stroke. Stroke. 2010; 41: 910-915 Crossref PubMed Scopus (194) Google Scholar but whether the presence of a subcortical infarction affects functional outcome following DHC remains unknown. Our aim was to determine if subcortical involvement in malignant MCA infarction is associated with independent ambulation one year following DHC.