Decompressive surgery <48 h from stroke onset reduces the prevalence of mortality and morbidity from malignant supratentorial infarction. We investigated if utilization of decompressive surgery changed in the Czech Republic (CZ) after the release of new guidelines regarding treatment of malignant brain infarction. The volume of decompressive surgery in 2009 in all centers in the CZ was assessed using the same methodology as in 2006. All neurosurgery departments in the CZ were asked to complete a questionnaire and asked to identify all cases of decompressive surgery for malignant brain infarction through a combination of discharge codes for "brain infarction" and "decompressive surgery" from electronic hospital charts. Data for 56 patients were obtained from 15 of the 16 neurosurgery departments in the CZ. The average age was 53 ± 13; number of males 20; median time to surgery was 48 h (range 24-62); median NIHSS score was 25 (IQR, 20-30); median infarct volume was 300 cm(3) [interquartile (IQR, 250-350)]; mean shift on CT was 10.6 ± 3.6 mm and size of hemicraniectomy was 125 cm(2) (IQR, 110-154). A favorable outcome was achieved in 45% of the patients. The number of procedures increased from 39 in 2,006 to 2,056 in 2009. Based on data from one stroke center, 10% suffered from malignant supratentorial infarction and 2.3% met the criteria for decompressive surgery. In 2009, as compared to 2006, the volume of decompressive surgery carried out moderately increased. However, procedures remained underutilized because only ~10% of those who needed decompressive surgery underwent surgery.

Department of Neurology Department of Neurosurgery and Department of Radiology Faculty Hospital Ostrava Tr 17 Listopadu 1790 708 52 Ostrava Czech Republic

Department of Neurology Faculty Hospital Ostrava Tr 17 Listopadu 1790 708 52 Ostrava Czech Republic

Department of Neurology International Clinical Research Center and Department of Neurosurgery St Anne Hospital Brno Czech Republic

Department of Neurology Na Homolce Hospital Prague Czech Republic

Department of Neurosurgery Bata Hospital Zlin Czech Republic

Department of Neurosurgery City Hospital Ostrava Czech Republic

Department of Neurosurgery Faculty Hospital Brno Czech Republic

Department of Neurosurgery Faculty Hospital Kralovske Vinohrady Prague Czech Republic

Department of Neurosurgery Faculty Hospital Motol Prague Czech Republic

Department of Neurosurgery Faculty Hospital Pilsen Czech Republic

Department of Neurosurgery Masaryk Hospital Usti nad Labem Czech Republic

Department of Neurosurgery Military Hospital Prague Prague Czech Republic

Department of Neurosurgery Regional Hospital Ceske Budejovice Czech Republic

Department of Neurosurgery Regional Hospital Liberec Czech Republic

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$a Decompressive surgery for malignant supratentorial infarction remains underutilized after guideline publication / $c M. Bar, R. Mikulik, D. Skoloudik, D. Czerny, R. Lipina, M. Sames, M. Choc, Z. Novak, M. Stary, V. Benes, M. Smrcka, M. Filip, D. Vondrackova, V. Chlouba, P. Suchomel, P. Haninec, R. Brzezny, V. Juran

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$a Decompressive surgery <48 h from stroke onset reduces the prevalence of mortality and morbidity from malignant supratentorial infarction. We investigated if utilization of decompressive surgery changed in the Czech Republic (CZ) after the release of new guidelines regarding treatment of malignant brain infarction. The volume of decompressive surgery in 2009 in all centers in the CZ was assessed using the same methodology as in 2006. All neurosurgery departments in the CZ were asked to complete a questionnaire and asked to identify all cases of decompressive surgery for malignant brain infarction through a combination of discharge codes for "brain infarction" and "decompressive surgery" from electronic hospital charts. Data for 56 patients were obtained from 15 of the 16 neurosurgery departments in the CZ. The average age was 53 ± 13; number of males 20; median time to surgery was 48 h (range 24-62); median NIHSS score was 25 (IQR, 20-30); median infarct volume was 300 cm(3) [interquartile (IQR, 250-350)]; mean shift on CT was 10.6 ± 3.6 mm and size of hemicraniectomy was 125 cm(2) (IQR, 110-154). A favorable outcome was achieved in 45% of the patients. The number of procedures increased from 39 in 2,006 to 2,056 in 2009. Based on data from one stroke center, 10% suffered from malignant supratentorial infarction and 2.3% met the criteria for decompressive surgery. In 2009, as compared to 2006, the volume of decompressive surgery carried out moderately increased. However, procedures remained underutilized because only ~10% of those who needed decompressive surgery underwent surgery.

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