Assessment of Outcomes After Decompressive Craniectomy—An Institutional-Based Study from India

Madhavi Karri, Balakrishnan Ramasamy, A. Varghese
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Abstract

Background: Decompressive craniectomy (DC) is a life-saving treatment modality for acute malignant strokes. We aimed to identify the risk factors and assess the long-term functional outcome in patients with malignant stroke undergoing DC. Methods: We conducted an ambispective study on patients (>18 years) undergoing DC between January 2016 and January 2019. Demographic data, stroke risk factors, clinical characteristics, and serial imaging findings were collected. We measured the functional outcomes using the National Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), modified Ranking Scale (mRS), and Barthel index (BI) at 3, 6, and 12 months postoperatively. We did univariate and multivariate regression analyses for the independent variables and outcomes. Results: On admission, the 93 patients (70 males) had a mean GCS of 11.77 (standard deviation [SD]: 2.90) and a mean NIHSS score of 13.65 (SD: 4.41). Diabetes (odds ratio [OR]: 1.76; 0.67-4.46, 95% confidence interval [CI]) and ischemic heart disease (OR: 4.50; 1.44-14.07, 95% CI) showed a positive correlation with the outcome. Forty patients underwent surgery within 48 h of stroke onset, while 53 patients were operated on after 48 h. Twenty-two (23.66%) patients died during the study period, and 55 patients (59.14%) had an mRS score <2 one year after the stroke. Conclusions: DC can produce favorable outcomes in patients with malignant strokes, and early aggressive intervention helps improve the prognosis and quality of life. Only a few studies were reported on the results of DC in stroke, much less from developing countries like India.
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印度一项基于机构的研究:颅底减压手术后疗效评估
背景:减压颅骨切除术(DC)是挽救急性恶性脑卒中生命的一种治疗方式。我们的目的是确定危险因素并评估恶性脑卒中患者行DC的长期功能结局。方法:我们对2016年1月至2019年1月期间接受DC治疗的患者(>18岁)进行了一项双向研究。收集了人口统计资料、卒中危险因素、临床特征和系列影像学结果。在术后3、6和12个月,我们使用国家健康卒中量表(NIHSS)、格拉斯哥昏迷量表(GCS)、改良排名量表(mRS)和Barthel指数(BI)来测量功能结局。我们对自变量和结果进行了单变量和多变量回归分析。结果:入院时93例患者(男性70例)平均GCS为11.77(标准差[SD]: 2.90),平均NIHSS评分为13.65 (SD: 4.41)。糖尿病(优势比[OR]: 1.76;0.67-4.46, 95%可信区间[CI])和缺血性心脏病(OR: 4.50;1.44-14.07, 95% CI)与预后呈正相关。40例患者在卒中发生后48 h内手术,53例患者在48 h后手术。研究期间死亡22例(23.66%),卒中后1年mRS评分<2的患者55例(59.14%)。结论:DC对恶性脑卒中患者预后良好,早期积极干预有助于改善预后和生活质量。只有少数研究报告了DC对中风的影响,来自印度等发展中国家的研究就更少了。
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