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Abstract：
BACKGROUND: In malignant cerebral infarction decompressive hemicraniectomy has demonstrated beneficial effects, but the optimum size of hemicraniectomy is still a matter of debate. Some surgeons prefer a large-sized hemicraniectomy with a diameter of more than 14 cm (HC > 14). We investigated whether this approach is associated with reduced mortality and an improved long-term functional outcome compared to a standard hemicraniectomy with a diameter of less than 14 cm (HC ≤ 14).
METHODS: Patients from the DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY) registry who received hemicraniectomy were dichotomized according to the hemicraniectomy diameter (HC ≤ 14 cm vs. HC > 14 cm). The primary outcome was modified Rankin scale (mRS) score ≤ 4 after 12 months. Secondary outcomes were in-hospital mortality, mRS ≤ 3 and mortality after 12 months, and the rate of hemicraniectomy-related complications. The diameter of the hemicraniectomy was examined as an independent predictor of functional outcome in multivariable analyses.
RESULTS: Among 130 patients (32.3% female, mean (SD) age 55 (11) years), the mean hemicraniectomy diameter was 13.6 cm. 42 patients (32.3%) had HC > 14. There were no significant differences in the primary outcome and mortality by size of hemicraniectomy. Rate of complications did not differ (HC ≤ 14 27.6% vs. HC > 14 36.6%, p = 0.302). Age and infarct volume but not hemicraniectomy diameter were associated with outcome in multivariable analyses.
CONCLUSIONS: In this post-hoc analysis, large hemicraniectomy was not associated with an improved outcome or lower mortality in unselected patients with malignant middle cerebral artery infarction. Randomized trials should further examine whether individual patients could benefit from a large-sized hemicraniectomy.
BACKGROUND: German Clinical Trials Register (URL: https://www.drks.de ; Unique Identifier: DRKS00000624).
METHODS: Patients from the DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY) registry who received hemicraniectomy were dichotomized according to the hemicraniectomy diameter (HC ≤ 14 cm vs. HC > 14 cm). The primary outcome was modified Rankin scale (mRS) score ≤ 4 after 12 months. Secondary outcomes were in-hospital mortality, mRS ≤ 3 and mortality after 12 months, and the rate of hemicraniectomy-related complications. The diameter of the hemicraniectomy was examined as an independent predictor of functional outcome in multivariable analyses.
RESULTS: Among 130 patients (32.3% female, mean (SD) age 55 (11) years), the mean hemicraniectomy diameter was 13.6 cm. 42 patients (32.3%) had HC > 14. There were no significant differences in the primary outcome and mortality by size of hemicraniectomy. Rate of complications did not differ (HC ≤ 14 27.6% vs. HC > 14 36.6%, p = 0.302). Age and infarct volume but not hemicraniectomy diameter were associated with outcome in multivariable analyses.
CONCLUSIONS: In this post-hoc analysis, large hemicraniectomy was not associated with an improved outcome or lower mortality in unselected patients with malignant middle cerebral artery infarction. Randomized trials should further examine whether individual patients could benefit from a large-sized hemicraniectomy.
BACKGROUND: German Clinical Trials Register (URL: https://www.drks.de ; Unique Identifier: DRKS00000624).
摘要：
背景：在恶性脑梗塞去骨瓣减压术中已显示出有益效果，但是大骨瓣切除术的最佳大小仍然是一个争论的问题。一些外科医生更喜欢直径超过14厘米（HC>14）的大型半切除术。我们调查了与直径小于14cm（HC≤14）的标准半切除术相比，该方法是否与死亡率降低和长期功能结局改善相关。
方法：根据大骨瓣直径（HC≤14cmvs.HC>14厘米）。主要结果为12个月后改良Rankin量表(mRS)评分≤4分。次要结果是院内死亡率，mRS≤3和12个月后的死亡率，和大骨瓣切除术相关并发症的发生率。在多变量分析中，检查了大骨瓣切除术的直径作为功能结局的独立预测因子。
结果：在130名患者中（32.3%为女性，平均（SD）年龄55（11）岁），平均半切除直径为13.6cm。42例（32.3%）患者的HC>14。根据大骨瓣切除术的大小，主要结局和死亡率没有显着差异。并发症的发生率没有差异(HC≤1427.6%与HC>1436.6%，p=0.302）。在多变量分析中，年龄和梗死体积而不是大骨瓣切除术直径与结果相关。
结论：在此事后分析中，在未选择的恶性大脑中动脉梗死患者中,大骨瓣切除术与改善预后或降低死亡率无关.随机试验应进一步检查个别患者是否可以从大型半切除术中受益。
背景：德国临床试验注册（URL：https://www.drks.de;唯一标识符:DRKS00000624)。
方法：根据大骨瓣直径（HC≤14cmvs.HC>14厘米）。主要结果为12个月后改良Rankin量表(mRS)评分≤4分。次要结果是院内死亡率，mRS≤3和12个月后的死亡率，和大骨瓣切除术相关并发症的发生率。在多变量分析中，检查了大骨瓣切除术的直径作为功能结局的独立预测因子。
结果：在130名患者中（32.3%为女性，平均（SD）年龄55（11）岁），平均半切除直径为13.6cm。42例（32.3%）患者的HC>14。根据大骨瓣切除术的大小，主要结局和死亡率没有显着差异。并发症的发生率没有差异(HC≤1427.6%与HC>1436.6%，p=0.302）。在多变量分析中，年龄和梗死体积而不是大骨瓣切除术直径与结果相关。
结论：在此事后分析中，在未选择的恶性大脑中动脉梗死患者中,大骨瓣切除术与改善预后或降低死亡率无关.随机试验应进一步检查个别患者是否可以从大型半切除术中受益。
背景：德国临床试验注册（URL：https://www.drks.de;唯一标识符:DRKS00000624)。
