Hemicraniectomy Also Beneficial for Older Patients
Increased survival without severe disability for older patients with middle-cerebral-artery infarction
FRIDAY, March 21, 2014 (HealthDay News) -- For older patients with middle-cerebral-artery infarction, early decompressive hemicraniectomy increases survival without severe disability, according to a study published in the March 20 issue of the New England Journal of Medicine.
Eric Jüttler, M.D., Ph.D., from the University of Heidelberg in Germany, and colleagues examined the benefit of early decompressive hemicraniectomy in older patients with complete or subtotal space-occupying middle-cerebral-artery infarction. Within 48 hours after symptom onset, 112 participants (aged 61 years or older) were randomized to conservative treatment in the intensive care unit (control group) or hemicraniectomy.
The researchers found that the proportion of patients who survived without severe disability was significantly higher in the hemicraniectomy group versus the control group (38 versus 18 percent; odds ratio, 2.91; P = 0.04). This difference was attributed to lower mortality in the hemicraniectomy group (33 versus 70 percent). No patients had a modified Rankin scale score of 0 to 2, while 7 percent of the hemicraniectomy group and 3 percent of controls had a score of 3; 32 and 15 percent, respectively, had a score of 4; and 28 and 13 percent, respectively, had a score of 5. Herniation was more frequent in the control group, while infections were more frequent in the hemicraniectomy group.
"Hemicraniectomy increased survival without severe disability among patients 61 years of age or older with a malignant middle-cerebral-artery infarction," the authors write.