Outcomes after decompressive craniectomy for ischemic stroke: a volumetric analysis

ABSTRACT Background Decompressive hemicraniectomy (DHC) is a treatment of space-occupying hemispheric infarct. Current surgical guidelines use criteria of age less than 60 and surgery within 48 hours of stroke onset. Objective The purpose of this study was to evaluate the neurologic outcome after DHC and evaluate the relationship of stroke volume and outcomes. Methods A retrospective review was performed for patients undergoing DHC for cerebral infarct from 2016 to 2019. Unfavorable outcome was defined as modified Rankin Scale (mRS) >3. Patients with pre-craniectomy magnetic resonance imaging (MRI) were selected as subset for volumetric stroke volume analysis using RAPID software (iSchemaView, Redwood City, California) with stroke volume defined as ADC Results 52 patients met the inclusion criteria. At 90 days, favorable outcome was achieved in 11 (21.2%) patients, and 41 (78.8%) patients had unfavorable outcomes (15 (29%) died). Surgery after 48 hours, age > 60, and multi-vessel distribution did not significantly affect 90 day mRS (p=0.091, p=0.111, and p=0.664, respectively). In volumetric subset analysis, 10 patients (31.3%) out of 41 achieved favorable outcomes, and no patients with volume of infarct >280cc had a favorable outcome. There was a trend of lower volumes associated with favorable outcomes, but this did not meet significance (favorable 207±68.7 vs unfavorable 262±117.1, p=0.163, FIGURE 1). Conclusion Outcomes after DHC for malignant hemispheric infarct were not affected by current accepted guidelines. Volume of infarct may have an effect on outcome after DHC. Further research to aid in predicting which patients will benefit from decompressive craniectomy is warranted.