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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(02): e95-e101
DOI: 10.1055/s-0042-1743106
Original Article

Predictive Mortality Factors after Decompressive Craniectomy in Ischemic Stroke

Fatores preditivos de mortalidade após craniectomia descompressiva em acidentes vasculares cerebrais isquêmicos
Maria Luísa Brito Almino Leite 
1   Universidade de Brasília, Brasília, DF, Brasil
,
Matheus Silva Leite 
2   Departament of Neurosurgery, Hospital de Base do Distrito Federal, Brasília, DF, Brasil
,
Fernando Diogo Barbosa 
2   Departament of Neurosurgery, Hospital de Base do Distrito Federal, Brasília, DF, Brasil
,
Iruena Moraes Kessler 
3   Department of Neurosurgery, Universidade de Brasília, Brasília, DF, Brasil
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Abstract

Background Decompressive craniectomy is a consolidated method for the treatment of malignant ischemic stroke (iS) in the territory of the middle cerebral artery. Thus, factors contributing to mortality constitute an important area of investigation.

Objective To evaluate the epidemiological clinical profile and predictors of mortality in a single-center population of patients undergoing decompressive craniectomy for the treatment of malignant iS.

Methods A single-center retrospective study was performed in 87 patients with malignant iS subjected to emergency decompressive craniectomy from January 2014 to December 2017. Age, gender, laterality, aphasia, time interval between disease onset and treatment, and clinical and neurological outcomes using the Glasgow coma scale were assessed. The patients were stratified by age: a group of participants 60 years old or younger, and a group of participants older than 60 years old for assessment of survival and mortality by the Kaplan-Meier test and log-rank comparison. The intensity of the association between demographic and clinical variables was evaluated by multivariate Cox regression.

Results Ischemic stroke was prevalent in patients with hypertension (63.29%). Seventy-seven (84%) patients had some type of postoperative complication, mostly pneumonia (42.8%). The risk of death was 2.71 (p = 0.0041) and 1.93 (p = 0.0411) times higher in patients older than 60 and with less than 8 points on the Glasgow coma scale, respectively.

Conclusion Malignant iS has a significant mortality rate. Age above 60 years and Glasgow coma scale values below 8 were statistically correlated with unfavorable prognosis.

Resumo

Contexto A craniectomia descompressiva é um método consolidado para o tratamento do acidente vascular cerebral isquêmico (AVCI) maligno no território da artéria cerebral média. No entanto, os fatores envolvidos na mortalidade constituem objeto de investigação.

Objetivo Avaliar o perfil clínico epidemiológico e os preditores de mortalidade em uma população unicêntrica de pacientes submetidos à craniectomia descompressiva para tratamento de acidente vascular isquêmico maligno.

Métodos Um estudo retrospectivo unicêntrico foi realizado com 87 pacientes com AVCI maligno submetidos à craniectomia descompressiva de emergência de janeiro de 2014 a dezembro de 2017. Idade, gênero, lateralidade, afasia, intervalo de tempo entre o início da doença e o tratamento, e escala de coma de Glasgow foram avaliados. Os pacientes foram estratificados por idade: um grupo com participantes com 60 anos de idade ou menos, e outro com participantes com mais de 60 anos para avaliação de sobrevida e mortalidade pelo teste de Kaplan-Meier e comparação log-rank. A intensidade da associação entre variáveis demográficas e clínicas foi avaliada por regressão multivariada de Cox.

Resultados Houve prevalência de hipertensos (63,29%). Setenta e sete (84%) dos pacientes tiveram algum tipo de complicação pós-operatória, com predomínio de pneumonia (42,8%). O risco de morte foi 2,71 e 1,93 maior em pacientes com mais de 60 anos e com menos de 8 pontos na escala de coma de Glasgow, respectivamente.

Conclusão O AVCI maligno ainda tem uma taxa de mortalidade significativa. Idade acima de 60 anos e valores da escala de coma de Glasgow abaixo de 8 foram estatisticamente correlacionados com um prognóstico desfavorável.

Keywords

ischemic stroke - cerebrovascular stroke - middle cerebral artery - decompressive craniectomy

Palavras-chave

acidente vascular cerebral isquêmico - AVC maligno - artéria cerebral média - craniectomia descompressiva


Publication History

Received: 15 March 2021

Accepted: 20 December 2021

Article published online:
25 February 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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