Decompressive surgery for malignant supratentorial infarction remains underutilized after guideline publication
Language English Country Germany Media print-electronic
Document type Comparative Study, Journal Article, Multicenter Study
- MeSH
- Decompression, Surgical statistics & numerical data trends MeSH
- Guideline Adherence * trends MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Brain Infarction epidemiology pathology surgery MeSH
- Neurosurgical Procedures statistics & numerical data trends MeSH
- Prevalence MeSH
- Aged MeSH
- Practice Guidelines as Topic standards MeSH
- Vascular Surgical Procedures statistics & numerical data trends MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Comparative Study MeSH
- Geographicals
- Czech Republic epidemiology MeSH
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.
See more in PubMed
Stroke. 1984 May-Jun;15(3):492-6 PubMed
Neurosurgery. 2005 Apr;56(4):681-92; discussion 681-92 PubMed
Arch Neurol. 1996 Apr;53(4):309-15 PubMed
Stroke. 2007 Sep;38(9):2518-25 PubMed
J Neurosurg. 2010 Oct;113(4):897-900 PubMed
Lancet Neurol. 2007 Mar;6(3):215-22 PubMed
Stroke. 2004 Feb;35(2):539-43 PubMed
Stroke. 2001 Sep;32(9):2117-23 PubMed
J Stroke Cerebrovasc Dis. 2011 May-Jun;20(3):251-4 PubMed
